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Primary Care Provider Focus Group Phone Recruitment Script
Assessing Problem Areas in Referrals for Chronic Hematologic Malignancies and Developing Interventions to Address Them
OMB: 0920-0836
IC ID: 191096
OMB.report
HHS/CDC
OMB 0920-0836
ICR 201004-0920-001
IC 191096
( )
Documents and Forms
Document Name
Document Type
Att 13_PCP Focus Group Phone Recruitment Script.092309.doc
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Primary Care Provider Focus Group Phone Recruitment Script
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-WORD
Att 13_PCP Focus Group Phone Recruitment Script.092309.doc
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
50
0
0
0
0
50
Annual IC Time Burden (Hours)
3
0
0
0
0
3
Annual IC Cost Burden (Dollars)
0
0
-166
0
0
166
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.