OMB
.report
Search
Audience Research on Self-Management Education
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 207102
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201501-0920-003
IC 207102
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Audience Research on Self-Management Education
Form and Instruction
Moderator's Guide
Attachment 3 - Moderators Guide 052313.docx
Form and Instruction
Screener
Attachment 2 - Eligibility Screener 052313.docx
Form and Instruction
Attachment 4- Informed Consent Form 052313.docx
Consent
IC Document
Attachment 5 - Materials 052313.docx
Materials
IC Document
DPH_HMTS Expedited Review Form 052313.docx
Expedited Review Form
IC Document
Attachment 1 - Research Plan - Burden Table 052313.docx
Supporting Information
IC Document
List of Attachments 052313.docx
List of Attachments
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Audience Research on Self-Management Education
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
none
Moderator's Guide
Attachment 3 - Moderators Guide 052313.docx
No
No
Printable Only
Form and Instruction
none
Screener
Attachment 2 - Eligibility Screener 052313.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
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 %
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
120
0
0
0
0
120
Annual IC Time Burden (Hours)
200
0
0
0
0
200
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Consent
Attachment 4- Informed Consent Form 052313.docx
05/29/2013
Materials
Attachment 5 - Materials 052313.docx
05/29/2013
Expedited Review Form
DPH_HMTS Expedited Review Form 052313.docx
05/29/2013
Supporting Information
Attachment 1 - Research Plan - Burden Table 052313.docx
05/29/2013
List of Attachments
List of Attachments 052313.docx
05/29/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.