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[NICPC] Child Abuse and Neglect Prevention Message Development
[OS] CDC/ATSDR Formative Research and Tool Development
OMB: 0920-1154
IC ID: 264017
OMB.report
HHS/CDC
OMB 0920-1154
ICR 202506-0920-010
IC 264017
( )
Documents and Forms
Document Name
Document Type
Form 0920-24BQ
[NICPC] Child Abuse and Neglect Prevention Message Development
Form and Instruction
0920-24BQ Att 1. CAN Survey and Consent
Att 1. CAN Survey and Consent.docx
Form and Instruction
0920-24BQ Att 3. CAN Focus Group Eligible Participant Screener 11.
Att 3. CAN Focus Group Eligible Participant Screener 11.21.23.docx
Form and Instruction
0920-24BQ Att 3. CAN Focus Group Eligible Participant Screener rev
Att 3. CAN Focus Group Eligible Participant Screener.docx
Form and Instruction
Supporting Statement A (0920-1154)_CAN.docx
Supporting Statement A (0920-1154)_CAN
IC Document
Supporting Statement B (0920-1154)_CAN.docx
Supporting Statement B (0920-1154)_CAN
IC Document
Att 9. STARS Determination_ACEs and CAN Message Testing.docx
Att 9. STARS Determination_ACEs and CAN Message Testing
IC Document
Att 2. CAN Survey Screenshots.pdf
Survey Screenshots
IC Document
Att 4. CAN Focus Group Guide and Consent_Consumers.docx
Att 4. CAN Focus Group Guide and Consent_Consumers
IC Document
Att 5. CAN Focus Group Guide and Consent_Parents.docx
Att 5. CAN Focus Group Guide and Consent_Parents
IC Document
Att 6. CAN Focus Group Guide and Consent_DirectServiceProviders.docx
Att 6. CAN Focus Group Guide and Consent_DirectServiceProviders
IC Document
Att 7. CAN Partner Interview Guide and Consent.docx
Att 7. CAN Partner Interview Guide and Consent
IC Document
Att 8. Privacy Impact Assessment.pdf
Att 8. Privacy Impact Assessment
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NICPC] Child Abuse and Neglect Prevention Message Development
Agency IC Tracking Number:
0920-1154-24BQ
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 and Instruction
0920-24BQ
Att 1. CAN Survey and Consent
Att 1. CAN Survey and Consent.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-24BQ
Att 3. CAN Focus Group Eligible Participant Screener 11.21.23
Att 3. CAN Focus Group Eligible Participant Screener 11.21.23.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-24BQ
Att 3. CAN Focus Group Eligible Participant Screener rev
Att 3. CAN Focus Group Eligible Participant Screener.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:
189
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
189
0
0
0
0
189
Annual IC Time Burden (Hours)
56
0
0
0
0
56
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A (0920-1154)_CAN
Supporting Statement A (0920-1154)_CAN.docx
12/20/2023
Supporting Statement B (0920-1154)_CAN
Supporting Statement B (0920-1154)_CAN.docx
12/20/2023
Att 9. STARS Determination_ACEs and CAN Message Testing
Att 9. STARS Determination_ACEs and CAN Message Testing.docx
12/20/2023
Survey Screenshots
Att 2. CAN Survey Screenshots.pdf
12/20/2023
Att 4. CAN Focus Group Guide and Consent_Consumers
Att 4. CAN Focus Group Guide and Consent_Consumers.docx
12/20/2023
Att 5. CAN Focus Group Guide and Consent_Parents
Att 5. CAN Focus Group Guide and Consent_Parents.docx
12/20/2023
Att 6. CAN Focus Group Guide and Consent_DirectServiceProviders
Att 6. CAN Focus Group Guide and Consent_DirectServiceProviders.docx
12/20/2023
Att 7. CAN Partner Interview Guide and Consent
Att 7. CAN Partner Interview Guide and Consent.docx
12/20/2023
Att 8. Privacy Impact Assessment
Att 8. Privacy Impact Assessment.pdf
12/20/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.