Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers

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⚠️ Notice: This information collection may be referencing outdated material.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
2013.05.30_Attachment 2 - Eligibility Screener.doc Other-WORD
2013 05 30_Attachment 3 - Moderators Guide.docx Other-WORD
2013.05.30_Attachment 1 - Research Plan - Burden Table.doc 2013 IC Document
2013.05.30_Attachment 4 - Consent Form.docx 2013 IC Document
2013.05.30_Attachment 5 - Materials.docx 2013 IC Document
2013.05.30_HMTS_Expedited_Form_CPPW_Focus_Groups[1].docx mini statement IC Document

Information Collection (IC) Details

IC Title:	Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers	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
Other-WORD			2013.05.30_Attachment 2 - Eligibility Screener.doc		No	No	Paper Only
Other-WORD			2013 05 30_Attachment 3 - Moderators Guide.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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	120	0	0	0	0	0
Annual IC Time Burden (Hours)	154	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2013	2013.05.30_Attachment 1 - Research Plan - Burden Table.doc	06/24/2013
2013	2013.05.30_Attachment 4 - Consent Form.docx	06/24/2013
2013	2013.05.30_Attachment 5 - Materials.docx	06/24/2013
mini statement	2013.05.30_HMTS_Expedited_Form_CPPW_Focus_Groups[1].docx	07/03/2013

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