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Testing Business-Case Videos for CDC's Division of Community Health
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 212298
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201501-0920-003
IC 212298
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Testing Business-Case Videos for CDC's Division of Community Health
Form
Interview Guide for Videos
Attachment 3_Interview guide for video testing with businesspeople (05-15-14) DCH Video Testing.docx
Form
Eligibility Screener for Business people
Attachment 4_Eligibility screener for businesspeople (05-15-14) DCH Video Testing.docx
Form
Survey for Video Testing
Attachment 5_Survey for video testing with awardees (05-15-14) DCH Video Testing.docx
Form
HMTS Expedited Review Form (07-01-14) DCH Video Testing.docx
Request for Expedited Review
IC Document
Attachment 1_Research plan and burden table (5-15-14) DCH Video Testing .docx
Research Plan
IC Document
Attachment 2_Videos for testing (05-15-14) DCH Video Testing.docx
Videos for Testing/Links
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Testing Business-Case Videos for CDC's Division of Community Health
Agency IC Tracking Number:
0920-14AND
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
none
Interview Guide for Videos
Attachment 3_Interview guide for video testing with businesspeople (05-15-14) DCH Video Testing.docx
No
Printable Only
Form
none
Eligibility Screener for Business people
Attachment 4_Eligibility screener for businesspeople (05-15-14) DCH Video Testing.docx
Yes
Yes
Fillable Fileable
Form
none
Survey for Video Testing
Attachment 5_Survey for video testing with awardees (05-15-14) DCH Video Testing.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
300
0
0
0
0
300
Annual IC Time Burden (Hours)
125
0
0
0
0
125
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Expedited Review
HMTS Expedited Review Form (07-01-14) DCH Video Testing.docx
07/09/2014
Research Plan
Attachment 1_Research plan and burden table (5-15-14) DCH Video Testing .docx
07/09/2014
Videos for Testing/Links
Attachment 2_Videos for testing (05-15-14) DCH Video Testing.docx
07/09/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.