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Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 204153
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201501-0920-003
IC 204153
( )
⚠️ Notice: This information collection may be referencing outdated material.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
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
View Information Collection (IC)
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:
Unchanged
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 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
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
Federal Enterprise Architecture Business Reference Module
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 %
Requested
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
336
Annual IC Time Burden (Hours)
492
0
0
0
0
492
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.