[NCZEID] Harmful Algal Blooms Shellfish Communication Evaluation

[OS] 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 25-0003 [NCZEID] Harmful Algal Blooms Shellfish Communication Evaluation Form
25-0003 Screener Attachment 1 - Eligibility Screener_FG.docx Form
25-0003 Eligibility Screener Attachment 3 - Eligible Participant Screener_2.21.25.docx Form
25-0003 Moderator Guide Attachment 8 - Moderator Guide_FG.docx Form
Supporting Statement A Algal Blooms.docx SSA IC Document
Supporting Statement B.docx SSB IC Document
Attachment 2 - Recruitment Materials_FG.docx Recruitment Material IC Document
Attachment 4 - Privacy Agreement.docx Privacy Agreement IC Document
Attachment 5 - Respondent Consent Form_FG.docx Respondent Consent IC Document
Attachment 6 - Standard Invitation_FG .docx Invitation IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Confirmation Email IC Document
Attachment 9 - Materials for testing.docx Material for Testing IC Document
GenIC Request HAB Communication Evaluation.docx GenIC Request IC Document
Attachment 10- Human Subjects Determination.pdf Human Subjects Determination IC Document

Information Collection (IC) Details

IC Title:	[NCZEID] Harmful Algal Blooms Shellfish Communication Evaluation	Agency IC Tracking Number:

IC Status: Unchanged

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	25-0003	Screener	Attachment 1 - Eligibility Screener_FG.docx	Yes	Yes	Fillable Fileable
Form	25-0003	Eligibility Screener	Attachment 3 - Eligible Participant Screener_2.21.25.docx	Yes	Yes	Fillable Fileable
Form	25-0003	Moderator Guide	Attachment 8 - Moderator Guide_FG.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: 532	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	532	532
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA	Supporting Statement A Algal Blooms.docx	02/21/2025
SSB	Supporting Statement B.docx	01/28/2025
Recruitment Material	Attachment 2 - Recruitment Materials_FG.docx	01/28/2025
Privacy Agreement	Attachment 4 - Privacy Agreement.docx	01/28/2025
Respondent Consent	Attachment 5 - Respondent Consent Form_FG.docx	01/28/2025
Invitation	Attachment 6 - Standard Invitation_FG .docx	01/28/2025
Confirmation Email	Attachment 7 - Participant Confirmation Email_FG.docx	01/28/2025
Material for Testing	Attachment 9 - Materials for testing.docx	01/28/2025
GenIC Request	GenIC Request HAB Communication Evaluation.docx	01/28/2025
Human Subjects Determination	Attachment 10- Human Subjects Determination.pdf	01/28/2025

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