HMTS Radiation Focus Group and Emergencies Infographics

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⚠️ Notice: This information collection may be referencing outdated material.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
Att C_RRS Screening Inst 091213.docx Other-Word
Att C-1 ORIG Screenng Instrmnt Word 20130912.docx Other-Word
Att E_Moderator Guide 20130912.docx Other-Word
Att C-2 ORIGScreenngInstrmntScreenshots.pdf Other-Word
Att E-1 ORIG Survey Questions Word 20130815.docx Other-WORD
Att E-2ORIGSurveyScreenshots8.19.pdf Other-WORD
Att A_RRS Protocol Summary 20130912.docx Att A_RRS Protocol Summary 20130912 IC Document
Att B_RRS Protocol 20130912 (2).docx Att B_RRS Protocol 20130912 (2) IC Document
Att D_RRS Participant Info Sheet 20130912.docx Att D_RRS Participant Info Sheet 20130912 IC Document
Att F_Radiation Risk Scale 20130806.pdf Att F_Radiation Risk Scale 20130806 IC Document
Radiation Risk Scale List of Attchmnts 20130806.docx Radiation Risk Scale List of Attchmnts 20130806 IC Document
Att A ORIG Protocol Summary 20130815.docx Att A ORIG Protocol Summary 20130815 IC Document
Att B ORIG Protocol 20130815.docx Att B ORIG Protocol 20130815 IC Document
Att D ORIG Prtcpnt Info Webpage 20130815.docx Att D ORIG Prtcpnt Info Webpage 20130815 IC Document
ORIG List of Attchmnts 20130815.docx ORIG List of Attchmnts 20130815 IC Document
HMTS Expedited Review Form Rad Risk Scale 20130806.pdf HMTS Expedited Review Form Rad Risk Scale 20130806 IC Document
HMTS Expedited Review Form Online Rad Infographics.pdf HMTS Expedited Review Form Online Rad Infographics IC Document

Information Collection (IC) Details

IC Title:	HMTS Radiation Focus Group and Emergencies Infographics	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Att E-1 ORIG Survey Questions Word 20130815.docx	Yes	Yes	Fillable Printable
Other-Word	Att C_RRS Screening Inst 091213.docx	No	No	Fillable Printable
Other-Word	Att C-1 ORIG Screenng Instrmnt Word 20130912.docx	Yes	Yes	Fillable Printable
Other-Word	Att E_Moderator Guide 20130912.docx	No	No	Fillable Printable
Other-Word	Att C-2 ORIGScreenngInstrmntScreenshots.pdf	Yes	Yes	Fillable Printable
Other-WORD	Att E-2ORIGSurveyScreenshots8.19.pdf	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,088	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	2,088	0	0	0	0	0
Annual IC Time Burden (Hours)	372	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att A_RRS Protocol Summary 20130912	Att A_RRS Protocol Summary 20130912.docx	09/16/2013
Att B_RRS Protocol 20130912 (2)	Att B_RRS Protocol 20130912 (2).docx	09/16/2013
Att D_RRS Participant Info Sheet 20130912	Att D_RRS Participant Info Sheet 20130912.docx	09/16/2013
Att F_Radiation Risk Scale 20130806	Att F_Radiation Risk Scale 20130806.pdf	09/16/2013
Radiation Risk Scale List of Attchmnts 20130806	Radiation Risk Scale List of Attchmnts 20130806.docx	09/16/2013
Att A ORIG Protocol Summary 20130815	Att A ORIG Protocol Summary 20130815.docx	09/16/2013
Att B ORIG Protocol 20130815	Att B ORIG Protocol 20130815.docx	09/16/2013
Att D ORIG Prtcpnt Info Webpage 20130815	Att D ORIG Prtcpnt Info Webpage 20130815.docx	09/16/2013
ORIG List of Attchmnts 20130815	ORIG List of Attchmnts 20130815.docx	09/16/2013
HMTS Expedited Review Form Rad Risk Scale 20130806	HMTS Expedited Review Form Rad Risk Scale 20130806.pdf	09/19/2013
HMTS Expedited Review Form Online Rad Infographics	HMTS Expedited Review Form Online Rad Infographics.pdf	09/19/2013

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