Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers New 600 164 0 Form and Instruction 0920-0572 Screening Instrument for Young Women
Form and Instruction 0920-0572 Survey Instrument for Young Women
Form and Instruction 0920-0572 Screening Instrument for Health Care Providers
Form and Instruction 0920-0572 Survey Instrument for Health Care Providers
Air Quality Information Initiative New 108 34 0 Form none Recruitment screener
Other-Focus Group Guide
American Academy of Pediatrics Oral Health Toolkit Research and Message Testing New 40 60 0 Other-Focus Group Guide
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers New 180 69 0 Form and Instruction n/a Screener for Consumers (Self-demanders and Self-expectors)
Form and Instruction n/a Screener for Consumers (Caregiver-demanders and Caregiver-expectors)
Form and Instruction n/a Pre-discussion Information Survey for Consumers (Self-demanders and Self-expectors)
Form and Instruction n/a Pre-discussion Information Survey for Consumers (Caregiver-demanders and Caregiver-expectors)
Form and Instruction n/a Online Focus Group Guide for Consumers
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals New 120 34 0 Form and Instruction n/a Screener for Health Care Professionals
Form and Instruction n/a Pre-Discussion Information Survey for Health Care Professionals
Form and Instruction n/a In-Depth Interview Guide for Health Care Professionals
Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain New 1143 169 0 Other-Invitation letter
Form none CDC Prescription Opioid Physician Survey
Other-Interview Guide
Asthma Control Communication Materials Field Testing (NCEH) New 448 128 0 Form and Instruction none Foduc Group Screener
Other-Discussion Guide
Form and Instruction none Youth Rating Worksheet
Form and Instruction none Caregiver Rating Worksheet
Form and Instruction none Youth Comparison Worksheet
Form and Instruction none Caregiver Comparison Worksheet
Asthma Control Initiative Communication Messaging and Materials Development New 336 96 0 Other-Focus Group Guide
Form and Instruction none Focus Group Screener
Be Antibiotics Aware Educational Message/Materials Assessment New 1304 359 0 Form n/a Be Antibiotics Aware Consumer Survey (BAACS)
Bring Your Brave Campaign Message Testing New 200 67 0 Form none Bring Your Brave Campaign Testing Survey
CDC/NCEH TO21: Outdoor Air Quality Focus Group New 192 84 0 Other-WORD
Other-WORD
Other-WORD
Domestic Readiness Initiative on Zika Virus Disease New 575 342 0 Form and Instruction 0920-0572 Attachment 4 - Provider Screener_1_13
Form and Instruction 0920-0572 Attachment 5 - Provider Survey_1_13
Form and Instruction 0920-0572 Attatchment 6 - FGPRScreener_1_13
Form and Instruction 0920-0572 Attachment 7 - FGPRGuide_1-13-17
Form and Instruction 0920-0572 ttachment2 - Consumer Screener for IDICONUS_1_13
Form and Instruction 0920-0572 Attachment 3 consumer IDI Guide_l1_13
Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials New 150 81 0 Form and Instruction NA Focus Group Screener
Form and Instruction NA Focus Group Guide
Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing New 125 73 0 Form and Instruction NA Community Leader - Focus Group Screening Instrument
Form and Instruction NA Men/Women Reproductive Age (18-49) - Focus Group Screening Instrument
Form and Instruction NA Community Leader - Focus Group Guide
Form and Instruction NA Men/Women Reproductive Age (18-49) - Focus Group Guide
Focus Group Research to Inform the Development of Mesages to change Social Norms New 96 144 0 Instruction
Form and Instruction Att. F1 Att. F1 Dads book
Form and Instruction Att. F2 Att. F2 Moms book
GenIC Testing of Spanish-language Messages for the National Diabetes New 180 158 0 Other-WORD
HEADS UP Audience Research Study New 280 165 0 Form and Instruction NA FOCUS GROUP SCREENER AND FOLLOW UP FOCUS GROUP SCREENER
Form and Instruction NA FOCUS GROUP AND FOLLOW UP FOCUS GROUP INSTRUMENT
HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico New 180 270 0 Form and Instruction NA Focus Group Discussion with Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika
Form and Instruction NA Focus Group Discussion with Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika
Form and Instruction NA Focus Group Discussion with Pregnant Women in Puerto Rico To Test Zika Prevention Messages
Form and Instruction NA In-depth Interview of Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika
Form and Instruction NA In-depth Interview of Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika
Form and Instruction NA In-depth Interview of Pregnant Women in Puerto Rico To Test Zika Prevention Messages
HMTS - Message testing among important public audiences in Puerto Rico New 240 60 0 Form and Instruction NA Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages
High Impact Prevention Message Testing (HIPMT) New 900 692 0 Form and Instruction NA Consumer Focus Group Guide
Form and Instruction NA Consumer IDI Guide
Form and Instruction NA Provider Focus Group Guide
Form and Instruction NA Provider IDI Guide
Form and Instruction NA Professional Focus Group Guide
Form and Instruction NA Professional IDI Guide
Form and Instruction NA Consumer - Brief Survey
Form and Instruction NA Provider - Brief Survey
Form and Instruction NA Professional - Brief Survey
Form and Instruction NA Consumer - Screener
Form and Instruction NA Provider - Screener
Form and Instruction NA Professional - Screener
Form and Instruction NA Consumer - Consent
Form and Instruction NA Provider - Consent
Form and Instruction NA Professional - Consent
Form and Instruction NA Consumer Web Survey
Form and Instruction NA Intercept Guide
Form and Instruction NA Screener - Consumer Web Survey
Form and Instruction NA Consent - Consumer Web Survey
Form and Instruction NA Consent - Intercept Survey
Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages New 60 15 0 Form and Instruction NA Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - English
Form and Instruction NA Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - Spanish
Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign New 1430 358 0 Form N/A Screen Shots of the Prescription Drug Overdose Survey
Other-Overview of Questions in the PDO Survey
Message Testing among Public Audiences in US Virgin Islands for Zika prevention New 60 15 0 Form and Instruction none Intercept interview for message testing
Message Testing with Mothers for CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO) New 2160 767 0 Form and Instruction n/a Screener and Survey for Online Participants (content is provided in screen shots and Word)
Form and Instruction n/a Screener and Moderator's Guide for In-person Focus Group Participants
Message testing among partners of pregnant women in Puerto Rico New 60 15 0 Form and Instruction NA Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - English
Form and Instruction NA Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - Spanish
Office of the Associate Director for Communication (OADC) Message and Material Feedback New 240 21 0 Form and Instruction NA OADC Message and Material Feedback Survey - Screener
Form and Instruction NA OADC Message and Material Feedback Survey - Health Material Questions
Older Adult Mobility Planning Brochure New 36 106 0 Form and Instruction none Participant Screener
Instruction
Other-Focus Group Guide
Radiation Concepts/Comparison Message Testing New 240 170 0 Form and Instruction none Interview Screener
Form and Instruction none Focus Group Screener
Other-Moderator's Guide
Other-Interview Guide
Re-entry Messaging Following a Radiation Emergency New 48 44 0 Other-WORD
Other-WORD
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Consumers New 198 24 0 Form n/a Screenshots of the Sepsis R2 Survey for Consumers
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers New 462 56 0 Form n/a Screenshots of the Sepsis Survey for Healthcare Professionals
Sepsis Educational Awareness Message/Materials Assessment - Consumers New 1594 598 0 Form none Sepsis Assessment - Consumers
Sepsis Educational Awareness Message/Materials Assessment - HCP New 786 295 0 Form none Sepsis Educational Awareness Assessment
Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival New 756 398 0 Form and Instruction N/A Screener
Form and Instruction N/A Informed Consent and Rescreening Form
Form and Instruction N/A Focus Group Discussion Guide for African American Women
Form and Instruction N/A Focus Group Discussion Guide for Hispanic Women
Form and Instruction N/A Focus Group Discussion Guide for African American Men
Form and Instruction N/A Focus Group Discussion Guide for Hispanic Men
Form and Instruction N/A Digital Ad Response Sheet (completed during focus groups with men)
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 15527 6131 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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