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Questionnaire Bank
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 187037
OMB.report
HHS/CDC
OMB 0920-0572
ICR 200904-0920-011
IC 187037
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:
2024-10-18 - Revision of a currently approved collection
2021-08-31 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
REVISED Health Message Testing System - Attachment 4 - Demographic Questions.doc
Other-Interview
Health Message Testing System - Attachment 5 - Market Research Experience Questions.doc
Other-Interview
Health Message Testing System - Attachment 6 - Introductory Questions.doc
Other-Interview
Health Message Testing System - Attachment 7 - Core Questions.doc
Other-Interview
Health Message Testing System - Attachment 8 - Activity-Task Questions.doc
Other-Interview
Health Message Testing System - Attachment 9 - Follow-Up Questions.doc
Other-Interview
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Questionnaire Bank
Agency IC Tracking Number:
IC Status:
Unchanged
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-Interview
REVISED Health Message Testing System - Attachment 4 - Demographic Questions.doc
Yes
No
Paper Only
Other-Interview
Health Message Testing System - Attachment 5 - Market Research Experience Questions.doc
Yes
No
Paper Only
Other-Interview
Health Message Testing System - Attachment 6 - Introductory Questions.doc
Yes
No
Paper Only
Other-Interview
Health Message Testing System - Attachment 7 - Core Questions.doc
Yes
No
Paper Only
Other-Interview
Health Message Testing System - Attachment 8 - Activity-Task Questions.doc
Yes
No
Paper Only
Other-Interview
Health Message Testing System - Attachment 9 - Follow-Up Questions.doc
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
10 %
Requested
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
6,000
0
0
0
0
6,000
Annual IC Time Burden (Hours)
3,000
0
0
0
0
3,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.