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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Group Testing to Effectively Plan and Tailor "Bring Your Brave" Communication Campaign Messages
Agency IC Tracking Number:
17YI
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
Other-WORD
Attachment B1- Discussion Guide for GP Families_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment B2 - Discussion Guide for AA or Black Families_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment B3- Discussion Guide for AJ Families_1.5.17.docx
No
Fillable Printable
Other-Screening
Attachment C1- Screening Instrument for GP Young Women_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment C2 - Screening Instrument for GP Families_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment C3- Screening Instrument for AA or Black Young Women_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment C4 - Screening Instrument for AA or Black Families_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment C5- Screening Instrument for AJ Young Women_1.5.17.docx
No
Fillable Printable
Other-WORD
Attachment C6 - Screening Instrument for AJ Families.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
480
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
480
0
480
0
0
0
Annual IC Time Burden (Hours)
96
0
96
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Legislation
Attachment A Legislative Authority_EARLY Act Reauthorization.pdf
03/27/2017
Respondent Information Sheet
Attachment D- Respondent Information Sheet.docx
03/27/2017
Att E. Material for Testing
Attachment E- Materials for Testing_v2 12.6.pptx
03/27/2017
Supporting Statement A
SS A _17YI_0327.17.doc
03/27/2017
Supporting Statement A
SS B 1.5.17.doc
03/27/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.