Reframing How We Talk About Alcohol

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Reframing How We Talk About Alcohol Form and Instruction
Att. B- Phase 1 In-depth Interview and Triad Guide.docx Other-Moderator Guide
Att. D- Phase 2 In-depth Interview and Triad Guide.docx Other-Moderator Guide
Screener Att. A-Screening Instrument.docx Form and Instruction
GenICRequest_Public Perception of Alcohol_032417.docx Request for Approval IC Document
Supporting Statement A_Reframing Alcohol_April 3 2017.doc Supporting Statement A IC Document
Support Statement B_ Reframing How We Talk About Alcohol.docx Supporting Statement B IC Document
Att. E- In-Depth Interview Consent Form.docx Interview consent IC Document
Att. F- Triad Discussion Consent Form.docx Discussion consent IC Document
Att. G - IRB Approval Letter.pdf IRB Approval IC Document
Att. C - SampleMessagesImages_Activity.docx Sample messages IC Document

Information Collection (IC) Details

IC Title:	Reframing How We Talk About Alcohol	Agency IC Tracking Number:	17ACB

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Screener	Att. A-Screening Instrument.docx	Yes	Yes	Fillable Fileable
Other-Moderator Guide			Att. B- Phase 1 In-depth Interview and Triad Guide.docx	Yes	Yes	Fillable Fileable
Other-Moderator Guide			Att. D- Phase 2 In-depth Interview and Triad Guide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 354	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	354	354
Annual IC Time Burden (Hours)	132	132
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	GenICRequest_Public Perception of Alcohol_032417.docx	04/03/2017
Supporting Statement A	Supporting Statement A_Reframing Alcohol_April 3 2017.doc	04/03/2017
Supporting Statement B	Support Statement B_ Reframing How We Talk About Alcohol.docx	04/03/2017
Interview consent	Att. E- In-Depth Interview Consent Form.docx	04/03/2017
Discussion consent	Att. F- Triad Discussion Consent Form.docx	04/03/2017
IRB Approval	Att. G - IRB Approval Letter.pdf	04/03/2017
Sample messages	Att. C - SampleMessagesImages_Activity.docx	04/03/2017

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