Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0572 Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders Form and Instruction
DCH Screener- General Public FG Engaged Public Triad.docx Instruction
Consent form- Community Leaders Triad.docx Instruction
Consent form- Engaged Public Triad.docx Instruction
Consent form- General Public FG.docx Instruction
0920-0572 Moderators Guide- Engaged Public Triad Moderators Guide- Engaged Public Triad.docx Form and Instruction
0920-0572 Moderators Guide- Community Leaders Triad Moderators Guide- Community Leaders Triad.docx Form and Instruction
0920-0572 Moderators Guide- General Public FG Moderators Guide- General Public FG.docx Form and Instruction
DCH Message Testing Supplement.docx DCH Message Testing Supplement IC Document
Burden table by audience and activity.docx Burden table by audience and activity IC Document
Overview of Recruitment Process for Community Leaders.docx Overview of Recruitment Process for Community Leaders IC Document
HMTS Expedited Review Form 090412.pdf HMTS Expedited Review Form 090412 IC Document

Information Collection (IC) Details

IC Title:	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572	Moderators Guide- Community Leaders Triad	Moderators Guide- Community Leaders Triad.docx	Yes	Yes	Printable Only
Form and Instruction	0920-0572	Moderators Guide- General Public FG	Moderators Guide- General Public FG.docx	Yes	Yes	Fillable Printable
Instruction			Consent form- Community Leaders Triad.docx	Yes	Yes	Printable Only
Instruction			Consent form- Engaged Public Triad.docx	Yes	Yes	Printable Only
Instruction			Consent form- General Public FG.docx	Yes	Yes	Printable Only
Form and Instruction	0920-0572	Moderators Guide- Engaged Public Triad	Moderators Guide- Engaged Public Triad.docx	Yes	Yes	Fillable Printable
Instruction			DCH Screener- General Public FG Engaged Public Triad.docx	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 336	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	336	0	0	0	0	0
Annual IC Time Burden (Hours)	492	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
DCH Message Testing Supplement	DCH Message Testing Supplement.docx	09/14/2012
Burden table by audience and activity	Burden table by audience and activity.docx	09/14/2012
Overview of Recruitment Process for Community Leaders	Overview of Recruitment Process for Community Leaders.docx	09/14/2012
HMTS Expedited Review Form 090412	HMTS Expedited Review Form 090412.pdf	09/18/2012

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