Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign

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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment-2_Screener-Tweens.docx Other-WORD
Attachment-3_Screener-Parents.docx Other-WORD
Attachment-4_Moderators-Guide-Tweens.docx Other-WORD
Attachment-5_Moderators-Guide-Parents.docx Other-WORD
Attachment-1_Background-Information.docx Att 1 Background InformaTION IC Document
Attachment-6_Consent-Form-Parent-of-Tween.docx Att 6_ Consent Form: Parents of Tween IC Document
Attachment-7_Assent-Form-Tweens.docx Att &_Assent Form: Tweens IC Document
Attachment-8_Consent-Form-Parents.docx Att 8_Consent Form: Parents IC Document
Attachment-9_Burden-Hours.docx Att 9_Burden Hours IC Document
ATSDR-Storyboard-Testing_HMTS-Expedited-Review-Form (2).pdf HMTS Expedited Review Form IC Document

Information Collection (IC) Details

IC Title:	Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign	Agency IC Tracking Number:	15FO

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Attachment-2_Screener-Tweens.docx	No	Paper Only
Other-WORD	Attachment-3_Screener-Parents.docx	No	Paper Only
Other-WORD	Attachment-4_Moderators-Guide-Tweens.docx	No	Paper Only
Other-WORD	Attachment-5_Moderators-Guide-Parents.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 96	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 1 Background InformaTION	Attachment-1_Background-Information.docx	11/24/2014
Att 6_ Consent Form: Parents of Tween	Attachment-6_Consent-Form-Parent-of-Tween.docx	11/24/2014
Att &_Assent Form: Tweens	Attachment-7_Assent-Form-Tweens.docx	11/24/2014
Att 8_Consent Form: Parents	Attachment-8_Consent-Form-Parents.docx	11/24/2014
Att 9_Burden Hours	Attachment-9_Burden-Hours.docx	11/24/2014
HMTS Expedited Review Form	ATSDR-Storyboard-Testing_HMTS-Expedited-Review-Form (2).pdf	11/24/2014

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