Pandemic Influenza Nonpharmaceutical Intervention Message Testing

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
Pandemic Influenza Nonpharmaceutical Intervention Message Testing Form and Instruction
Screener Screener Protocol 071312.docx Form and Instruction
Moderator's Guide Moderator Guide_071312.docx Form and Instruction
Incentive Justification_071312.docx Incentive Justification IC Document
Focus Group Materials_071312.docx Focus Group Materials IC Document
HMTS NCEZID Expedited Review Form_071312.pdf GenIC Review Form - Project Proposal IC Document
Privacy Act Determination_071312.docx Privacy Act Determination IC Document

Information Collection (IC) Details

IC Title:	Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	none	Screener	Screener Protocol 071312.docx		No	No	Paper Only
Form and Instruction	none	Moderator's Guide	Moderator Guide_071312.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	90	0	0	0	0	0
Annual IC Time Burden (Hours)	180	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Incentive Justification	Incentive Justification_071312.docx	07/23/2012
Focus Group Materials	Focus Group Materials_071312.docx	07/23/2012
GenIC Review Form - Project Proposal	HMTS NCEZID Expedited Review Form_071312.pdf	07/23/2012
Privacy Act Determination	Privacy Act Determination_071312.docx	07/23/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.