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Spanish Trench Safety CD-ROM
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 211317
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201111-0920-003
IC 211317
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Spanish Trench Safety CD-ROM
Form
Survey - Spanish
Attachment B-Survey Items Spanish-Flynn_4-11-14.docx
Form
Recruitment Script
Attachment D-Recruitment Script Spanish-Flynn_4-14-14.docx
Form
HMTS_Expedited_Review_Form_4-11-14.pdf
HMT Request Template
IC Document
Attachment C-Survey Items English-Flynn_4-14-14.docx
Survey - English
IC Document
Attachment E-Recruitment Script English-Flynn_4-14-14.docx
Recruitment - English
IC Document
Attachment A-Study Protocol-Flynn_4-14-14.docx
Study Protocol
IC Document
Attachment F - Informed Consent_4-14-14.docx
Informed Consent
IC Document
Attachment G-IncentiveJustification-Flynn_4-14-14.docx
Incentive Justification
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Spanish Trench Safety CD-ROM
Agency IC Tracking Number:
14VJ
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
none
Survey - Spanish
Attachment B-Survey Items Spanish-Flynn_4-11-14.docx
Yes
No
Paper Only
Form
none
Recruitment Script
Attachment D-Recruitment Script Spanish-Flynn_4-14-14.docx
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
100
0
100
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
HMT Request Template
HMTS_Expedited_Review_Form_4-11-14.pdf
04/17/2014
Survey - English
Attachment C-Survey Items English-Flynn_4-14-14.docx
04/17/2014
Recruitment - English
Attachment E-Recruitment Script English-Flynn_4-14-14.docx
04/17/2014
Study Protocol
Attachment A-Study Protocol-Flynn_4-14-14.docx
04/17/2014
Informed Consent
Attachment F - Informed Consent_4-14-14.docx
04/17/2014
Incentive Justification
Attachment G-IncentiveJustification-Flynn_4-14-14.docx
04/17/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.