Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Test of Effectiveness of Screening Recruitment Messages among African American Women in North Carolina
Agency IC Tracking Number:
IC Status:
New
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
none
Att1a - Prediscussion Info Sheet AA
Att A1a - PreDIS_AAW_10 19 2011.doc
No
No
Paper Only
Form
none
Att1b - Post-discussion Info Sheet AA
Att A1b - PostDIS_AAW 10 19 2011.doc
No
No
Paper Only
Form
none
AttA2 - Prediscussion Info Sheet Latina
Att A2 - PreDIS_LATINAS_10 19 2011.doc
No
No
Paper Only
Form
none
AttE1 - Recruitment Screener AA
Att E1 - Recruitment Screener-AAW.doc
No
No
Paper Only
Form
none
AttE2 - Recruitment Screener Latina
Att E2 - Recruitment Screener_LATINAS.doc
No
No
Paper Only
Form and Instruction
none
AttJ1 - Moderator Guide AA
Att J1 - Moderator Guide_AAW_10 25 2011.docx
No
No
Paper Only
Form and Instruction
none
AttJ2 - Moderator Guide Latina
Att J2 - Moderator Guide_LATINAS_10 19 2011.docx
No
No
Paper Only
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:
581
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
581
0
0
0
0
0
Annual IC Time Burden (Hours)
315
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
AttB - Communication Materials
Att B - Communication Materials.pdf
11/09/2011
AttC1 - Radio Health Messages
Att C1 - Birthday Party.wav
11/09/2011
AttC2 - Radio Health Messages
Att C2 - MAYA NEW_1-15-09 (in mp3 format).mp3
11/09/2011
AttC3 - Radio Health Messages
Att C3 - Oh Harold (in mp3 format).mp3
11/09/2011
AttD1 - Recruitment Flyer AA
Att D1 - Recruitment Flyer_AAW.pdf
11/09/2011
AttD2 - Recruitment Flyer Latina
Att D2 - Recruitment Flyer_LATINAS.pdf
11/09/2011
AttF - Observer Nondisclosure
Att F - Observer Confidentiality_10 26 2011.docx
11/09/2011
AttG - Nondisclosure with Local Sites
Att G - Confidentiality Agreement with LSRs.doc
11/09/2011
AttH1 - Informed Consent AA
Att H1 - Informed Consent_AAW_11 03 2011.doc
11/09/2011
AttH2 - Informed Consent Latina
Att H2 - Informed Consent_LATINAS_11 03 2011.doc
11/09/2011
AttK - Moderator Version Prediscussion Sheet
Att K - Moderator PDIS.docx
11/09/2011
AttI - IRB Approval
Att I - IRB approval.doc
11/09/2011
AttL - Sample Topline Summary
Att L - Sample Topline Summary.pdf
11/09/2011
Supporting Statement A
NC Project OMB Part A_11 03 2011.docx
11/09/2011
Supporting Statement B
NC Project OMB Part B_10 19 2011.docx
11/09/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.