CDC/NCEH TO21: Outdoor Air Quality Focus Group

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⚠️ Notice: This information collection may be referencing outdated material.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
Appx A-Moderator’s Guide for At-Risk Adul.docx Other-WORD
Appx B-Moderator’s Guide for Parents of At-Risk Children.docx Other-WORD
Appx H-Recruitment Screener.docx Other-WORD
HMTS Expedited Review Form-NCEH TO21OtdrAirQltyFcsGrps.docx Request for Approval IC Document
Protocol-NCEH TO21 Outdoor Air Quality Focus Groups.docx Protocol IC Document
Appx C-Behavioral Intentions Activity (At-RiskAdults).docx Appx C- Behavioral Intentions Activity (At-Risk Adults) IC Document
Appx D-Behavioral Intentions Activity (PrntsAt-RskChldrn).docx Appx D_Behavioral Intentions Activity (Parents of At-Risk Children) IC Document
Appx E -Air Quality and Physical Activity Infographic.docx Appx E_ Air Quality and Physical Activity Infographic IC Document
Appx F - Weather Channel Breathing Index Webpage.docx Appx F_Weather Channel Breathing Index Webpage IC Document
Appx G US EPA AirNow.gov Website.docx Appx G_ US EPA AirNow.gov Website IC Document
Appx I - Incentive Receipt Form.docx Appx I_ Incentive Receipt Form IC Document
Appx J -Participant Information Sheet .docx Appx J_Participant Information Sheet IC Document
Appx K - Consent Form .docx Appx K_Consent Form IC Document

Information Collection (IC) Details

IC Title:	CDC/NCEH TO21: Outdoor Air Quality Focus Group	Agency IC Tracking Number:	16ABG

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Appx H-Recruitment Screener.docx	No	Paper Only
Other-WORD	Appx A-Moderator’s Guide for At-Risk Adul.docx	No	Paper Only
Other-WORD	Appx B-Moderator’s Guide for Parents of At-Risk Children.docx	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 192	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	192	192
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	HMTS Expedited Review Form-NCEH TO21OtdrAirQltyFcsGrps.docx	04/13/2016
Protocol	Protocol-NCEH TO21 Outdoor Air Quality Focus Groups.docx	04/13/2016
Appx C- Behavioral Intentions Activity (At-Risk Adults)	Appx C-Behavioral Intentions Activity (At-RiskAdults).docx	04/13/2016
Appx D_Behavioral Intentions Activity (Parents of At-Risk Children)	Appx D-Behavioral Intentions Activity (PrntsAt-RskChldrn).docx	04/13/2016
Appx E_ Air Quality and Physical Activity Infographic	Appx E -Air Quality and Physical Activity Infographic.docx	04/13/2016
Appx F_Weather Channel Breathing Index Webpage	Appx F - Weather Channel Breathing Index Webpage.docx	04/13/2016
Appx G_ US EPA AirNow.gov Website	Appx G US EPA AirNow.gov Website.docx	04/13/2016
Appx I_ Incentive Receipt Form	Appx I - Incentive Receipt Form.docx	04/13/2016
Appx J_Participant Information Sheet	Appx J -Participant Information Sheet .docx	04/13/2016
Appx K_Consent Form	Appx K - Consent Form .docx	04/13/2016

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