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Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 214010
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201501-0920-003
IC 214010
( )
⚠️ Notice: This information collection may be referencing outdated material.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
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
View Information Collection (IC)
IC Title:
Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign
Agency IC Tracking Number:
15FO
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
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
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:
96
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
96
0
0
0
0
96
Annual IC Time Burden (Hours)
48
0
0
0
0
48
Annual IC Cost Burden (Dollars)
0
0
0
0
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.