CDC and ATSDR Health Message Testing System

Forms and Documents

Document Name	Status
Form 0920-0572 CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey Form	New
Form 0920-0572 Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support Form and Instruction	New
Form 0920-20PT Health Communications Testing for Latent Tuberculosis Infections Campaign Form and Instruction	New
Form 0920-0572 CDC Older Adult Injury Prevention Creative Campaign Survey Form and Instruction	New
Form 0920-0572 Message Testing: Radiation Emergencies and Cancer Risk Form and Instruction	New
Form 0920-0572 Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach Form and Instruction	New
Form 0920-20MU Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing Form and Instruction	New
Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers Form	New
Form 0920-0572 Assessment for the Get Ahead of Sepsis Consumer Campaign Form and Instruction	New
Assessment for the Be Antibiotics Aware Campaign - Health Care Providers Form	New
Form 0920-0572 Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign Form and Instruction	New
Form 0920-0572 Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener Form and Instruction	New
Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults Form and Instruction	New
Form 0920-0572 Crisis Next Door Campaign Assessment Form and Instruction	New
Form 0920-0572 Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity Form and Instruction	New
Form 0920-0572 Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences Form and Instruction	New
Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs) Form and Instruction	New
Get Ahead of Sepsis for Healthcare Providers Form	New
NIOSH Manual of Analytical Methods Survey Form and Instruction	New
A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death Form and Instruction	New
Form 0920-0572 Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing Form and Instruction	New
Form 0920-0572 Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension Form and Instruction	New
Form 0920-0572 Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults Form and Instruction	New
Form 0920-0572 Sexual Health Study for Gay and Bisexual Men Form and Instruction	New
Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak Form and Instruction	New
SS-PartB-HMTS .docx Supporting Statement B	2018-06-14
SS-Part A HMTS .docx Supporting Statement A	2018-06-14
Attachment 11 - IRB Ruling 060308.doc Supplementary Document	2018-06-12
Attachment 10 - Examples-Data Collection Instruments 060308.doc Supplementary Document	2018-06-12
Attachment 9-FollowUpQuestions.docx Supplementary Document	2018-06-12
Attachment 8-ActivityTaskQuestions.docx Supplementary Document	2018-06-12
Attachment 7-CoreQuestions.docx Supplementary Document	2018-06-12
Attachment 6-IntroductoryQuestions.docx Supplementary Document	2018-06-12
Attachment 5-MarketResearchExpQuestions.docx Supplementary Document	2018-06-12
Attachment 4-DemographicQuestions.docx Supplementary Document	2018-06-12
60day FRN.pdf Supplementary Document	2018-06-12
Att 1-AuthLegislation.pdf Supplementary Document	2018-06-12

IC Document Collections

IC ID	Document Title	Status
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey Form	New
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support Form and Instruction	New
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign Form and Instruction	New
242277	CDC Older Adult Injury Prevention Creative Campaign Survey Form and Instruction	New
242069	Message Testing: Radiation Emergencies and Cancer Risk Form and Instruction	New
241857	Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach Form and Instruction	New
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing Form and Instruction	New
240040	National Firefighter Registry Other-WORd	New
239897	Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers Form	New
239892	Assessment for the Get Ahead of Sepsis Consumer Campaign Form and Instruction	New
239891	Assessment for the Be Antibiotics Aware Campaign - Health Care Providers Form	New
239863	Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign Form and Instruction	New
239722	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener Form and Instruction	New
238568	Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults Form and Instruction	New
238053	Crisis Next Door Campaign Assessment Form and Instruction	New
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity Form and Instruction	New
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences Form and Instruction	New
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs) Form and Instruction	New
237852	Get Ahead of Sepsis for Healthcare Providers Form	New
237741	Be Antibiotic Aware Campaign Other-Focus group guide	New
237688	NIOSH Manual of Analytical Methods Survey Form and Instruction	New
237042	A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death Form and Instruction	New
236245	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing Form and Instruction	New
234826	Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension Form and Instruction	New
234749	Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults Form and Instruction	New
233703	Sexual Health Study for Gay and Bisexual Men Form and Instruction	New
232694	Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak Form and Instruction	New

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 201806-0920-001
Status: Active	Previous ICR Reference No: 201502-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0572
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2018
	Date Received in OIRA: 07/11/2018
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved
Responses	55,575	0	0
Time Burden (Hours)	7,410	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC must communicate about hazards, outbreaks and other emergencies that present an urgent health threat to the public. Untested messages can waste communication resources and opportunities because the messages can be perceived as unclear or irrelevant. OADC-CDC requests a reinstatement without change for the generic clearance for an expedited review of items to be used in health message testing to ensure the public will understand health messages and take recommended action.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 21776	05/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 32124	07/11/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 27

IC Title	Form No.	Form Name
Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak	none	Message Testing Instrument
Assessment for the Get Ahead of Sepsis Consumer Campaign	0920-0572, 0920-0572	GAOS Consumer Survey Pre-test HMTS ,   GAOS Consumer Survey Post-test HMTS
Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	none, none	BAA Pretest - Heath care providers ,   BAA Posttest - Health care providers
Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	PWD Screener Online Survey ,   PWD Online Survey ,   HCP Screener In Depth Interview ,   HCP In Depth Interview Guide ,   HCP Screener Online Survey ,   HCP Online Survey ,   PWD Focus Group Moderators Guide ,   PWD Screener for Focus Groups
A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	n/a, n/a	Recruitment Script and Screener ,   Focus Group Moderator's Guide
Message Testing: Radiation Emergencies and Cancer Risk	0920-0572	Message Testing Survey
CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	CDC Alcohol - Creative Concept Testing Rating Worksheet ,   CDC Alcohol Creative Concept Testing Ranking Worksheet - Concerned ,   Creative Concept Testing Ranking Worksheet Uncon&Noncom ,   Creative Concept Testing Rating - concerned ,   Screener
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener	0920-0572	Focus Group Screener - Revised
Be Antibiotic Aware Campaign	none, none, none, none, none	Screener for adults ,   Screener for Nursing Home Caregivers ,   Screener for SS women - English ,   Screener for SS Women - Spanish ,   Screener for Urgent Care adults
CDC Older Adult Injury Prevention Creative Campaign Survey	0920-0572	Older Adult Injury Prevention Creative Campaign Survey
National Firefighter Registry
Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach	0920-0572, 0920-0572, 0920-0572	Focus Group Screener ,   Focus Group Guide English ,   Focus Group Guide Spanish
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing	0920-0572, 0920-0572, 0920-0572	Focus Group Screener ,   Focus Group Discussion Guide ,   Audience Segmentation Survey
Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults	0920-0572, 0920-0572	Interview Guide ,   Screening Form
Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a	Screening Form for Dentists ,   Screening Form for Hospitalists ,   Screening Form for Nurses in Nursing Homes ,   Screening Form for Community Pharmacists ,   Screening Form for Advanced Practice Providers and Physicians in Nursing Homes ,   Interviewer Guide for Dentists ,   Interviewer Guide for Hospitalists ,   Interviewer Guide for Nurses in Nursing Homes ,   Interviewer Guide for Community Pharmacists ,   Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes
Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults	n/a, n/a	Screener and Focus Group Invitation ,   Focus Group Moderators Guide
Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers	none, none	GAOS Pretest - Health care providers ,   GAOS - Posttest - Health care providers
Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	0920-0572, 0920-0572, 0920-0572, 0920-0572	HMTS Evaluation Screener ,   HMTS Evaluation Consent Form ,   HMTS Worksheet Activity ,   HMTS Evaluation IDI Guide
Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Cancer Patients and Caregivers Mod Guide ,   Men Aged 65 and Older Mod Guide ,   Sepsis Survivors and Caregivers Mod Guide ,   Women Who Care for Aging Parent Mod Guide ,   Women Who Care for Child Mod Guide ,   Women Who Primarily Speak Spanish Mod Guide En ,   Cancer Patients Screener ,   Caregivers to Cancer Screener ,   Caregivers to Sepsis Survivors Screener ,   Men Aged 65 and Older Screener ,   Sepsis Survivors Screener ,   Women who Care for Aging Parent Screener ,   Women Who Care for Child Screener ,   Women Who Speak Spanish Screener (Eng)
Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign	0920-0572, 0920-0572	BAACS Survey FINAL PRETEST ,   BAA Consumer Survey_FINAL POSTTEST
Crisis Next Door Campaign Assessment	0920-0572, 0920-0572	Crisis Next Door Screener ,   Crisis Next Door Questionnaire
Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screener Diabetes Educators ,   Screener Health Care Providers ,   Screener People with DM ,   Diabetes Educators Survey ,   Health Care Providers Survey ,   Person with DM had DSMES Survey ,   Person with DM not had DSMES Survey
Health Communications Testing for Latent Tuberculosis Infections Campaign	0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT	Recruitment Screener_Consumer ,   Recruitment Screener_Nurse-NP-PA ,   Moderator Guide-IDI_Physician ,   Moderator Guide-FG_Nurse-NP-PA ,   Moderator Guide-FG_Consumer ,   Consent Form_Consumer ,   Recruitment Screener_Physician ,   Consent Form_Nurse-NP-PA ,   Consent Form_Physician
Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	0920-20MU, 0920-20MU, 0920-20MU, 0920-20MU, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screening/Eligibility Form ,   Guide for Adults 65+ ,   Guide for Parents ,   Guide for ESL Adults ,   Anthrax Antibiotics & Children Fact Sheet ,   Anthrax Get Vaccinated Fact Sheet ,   Anthrax Pregnancy Fact Sheet ,   Anthrax General Fact Sheet ,   Anthrax POD Fact Sheet
Sexual Health Study for Gay and Bisexual Men	0920-0572, 0920-0572	Screener - Understanding Sexual Health Messaging among Men who have Sex with Men ,   Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men
NIOSH Manual of Analytical Methods Survey	n/a	NMAM Customer Satisfaction Survey
Get Ahead of Sepsis for Healthcare Providers	none, none, none	Screener - EMS Personnel ,   Screener - LTC Med tech/sitter ,   Screener - LTC Nurses

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,575	0	0	0	0	55,575
Annual Time Burden (Hours)	7,410	0	0	0	0	7,410
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,550,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/11/2018

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