Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women New 272 115 0 Form and Instruction 0920-0572 Focus Group Recruitment Script and Screener
Form 0920-0572 Focus Group Discussion Guide
Other-Password Protected file
Other-Password Protected file
A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death New 150 245 0 Form and Instruction n/a Recruitment Script and Screener
Form and Instruction n/a Focus Group Moderator's Guide
Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign New 180 45 0 Form and Instruction 0920-0572 BAACS Survey FINAL PRETEST
Form and Instruction 0920-0572 BAA Consumer Survey_FINAL POSTTEST
Assessment for the Be Antibiotics Aware Campaign - Health Care Providers New 270 68 0 Form none BAA Pretest - Heath care providers
Form none BAA Posttest - Health care providers
Assessment for the Get Ahead of Sepsis Consumer Campaign New 360 90 0 Form and Instruction 0920-0572 GAOS Consumer Survey Pre-test HMTS
Form and Instruction 0920-0572 GAOS Consumer Survey Post-test HMTS
Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers New 450 113 0 Form none GAOS Pretest - Health care providers
Form none GAOS - Posttest - Health care providers
Be Antibiotic Aware Campaign New 464 129 0 Other-Focus group guide
Form and Instruction none Screener for adults
Other-Focus group guide
Form and Instruction none Screener for Nursing Home Caregivers
Other-Focus group guide
Other-Focus group guide
Form and Instruction none Screener for SS women - English
Form and Instruction none Screener for SS Women - Spanish
Other-Focus group guide
Form and Instruction none Screener for Urgent Care adults
Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support New 3144 477 0 Form and Instruction 0920-0572 PWD Screener for Focus Groups
Form and Instruction 0920-0572 PWD Focus Group Moderators Guide
Form and Instruction 0920-0572 PWD Screener Online Survey
Form and Instruction 0920-0572 PWD Online Survey
Form and Instruction 0920-0572 HCP Screener In Depth Interview
Form and Instruction 0920-0572 HCP In Depth Interview Guide
Form and Instruction 0920-0572 HCP Screener Online Survey
Form and Instruction 0920-0572 HCP Online Survey
CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey New 596 397 0 Form 0920-0572 CDC Alcohol - Creative Concept Testing Rating Worksheet
Form 0920-0572 CDC Alcohol Creative Concept Testing Ranking Worksheet - Concerned
Form 0920-0572 Creative Concept Testing Ranking Worksheet Uncon&Noncom
Form 0920-0572 Creative Concept Testing Rating - concerned
Instruction
Instruction
Instruction
Instruction
Form 0920-0572 Screener
CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam New 600 143 0 Form and Instruction n/a Recruitment Screener (English)
Form and Instruction n/a Recruitment Screener (Vietnamese)
Form and Instruction n/a Virtual Focus Group Guide for Consumers (English)
Form and Instruction n/a Virtual Focus Group Guide for Consumers (Vietnamese)
CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam New 40 17 0 Form and Instruction n/a Recruitment Screener for Nurse Practitioners and Physician Assistants
Form and Instruction n/a Recruitment Screener for Physicians
Form and Instruction n/a Guide for Virtual Interview with Nurse Practitioners or Physician Assistants
Form and Instruction n/a Guide for Virtual Interview with Physicians
CDC Older Adult Injury Prevention Creative Campaign Survey New 500 83 0 Form and Instruction 0920-0572 Older Adult Injury Prevention Creative Campaign Survey
Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak New 2400 200 0 Form and Instruction none Message Testing Instrument
Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing New 64 18 0 Form and Instruction 0920-20MU Screening/Eligibility Form
Form and Instruction 0920-20MU Guide for Adults 65+
Form and Instruction 0920-20MU Guide for Parents
Form and Instruction 0920-20MU Guide for ESL Adults
Form 0920-0572 Anthrax Antibiotics & Children Fact Sheet
Form 0920-0572 Anthrax Get Vaccinated Fact Sheet
Form 0920-0572 Anthrax Pregnancy Fact Sheet
Form 0920-0572 Anthrax General Fact Sheet
Form 0920-0572 Anthrax POD Fact Sheet
Crisis Next Door Campaign Assessment New 6315 774 0 Form and Instruction 0920-0572 Crisis Next Door Screener
Form and Instruction 0920-0572 Crisis Next Door Questionnaire
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing New 1896 216 0 Form and Instruction 0920-0572 Focus Group Screener
Form and Instruction 0920-0572 Focus Group Discussion Guide
Form and Instruction 0920-0572 Audience Segmentation Survey
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener New 64 5 0 Form and Instruction 0920-0572 Focus Group Screener - Revised
Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension New 285 119 0 Form and Instruction 0920-0572 HMTS Evaluation Screener
Form and Instruction 0920-0572 HMTS Evaluation Consent Form
Form and Instruction 0920-0572 HMTS Worksheet Activity
Form and Instruction 0920-0572 HMTS Evaluation IDI Guide
Get Ahead of Sepsis for Healthcare Providers New 162 38 0 Form none Screener - EMS Personnel
Form none Screener - LTC Med tech/sitter
Form none Screener - LTC Nurses
Other-Moderator Guide
Other-Moderator Guide
Other-Moderator Guide
Health Communications Testing for Latent Tuberculosis Infections Campaign New 1488 355 0 Form and Instruction 0920-20PT Recruitment Screener_Consumer
Form and Instruction 0920-20PT Recruitment Screener_Nurse-NP-PA
Form and Instruction 0920-20PT Recruitment Screener_Physician
Form and Instruction 0920-20PT Moderator Guide-IDI_Physician
Form and Instruction 0920-20PT Moderator Guide-FG_Nurse-NP-PA
Form and Instruction 0920-20PT Moderator Guide-FG_Consumer
Form 0920-20PT Consent Form_Consumer
Form 0920-20PT Consent Form_Nurse-NP-PA
Form 0920-20PT Consent Form_Physician
Informing Development of CDC Content about Sexually Transmitted Diseases: Focus Groups with Men Who Have Sex With Men New 95 106 0 Form and Instruction n/a Recruitment Guide for MSM
Form and Instruction n/a Moderator Guides for Web/Telephone Focus Groups
Informing Development of CDC Content about Sexually Transmitted Diseases: Interviews with Healthcare Providers New 40 35 0 Form and Instruction n/a Recruitment Guide for Healthcare Professionals
Form and Instruction n/a Moderator Guides for Interviews with Healthcare Professionals
Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity New 1400 150 0 Form and Instruction 0920-0572 Screener Diabetes Educators
Form and Instruction 0920-0572 Screener Health Care Providers
Form and Instruction 0920-0572 Screener People with DM
Form and Instruction 0920-0572 Diabetes Educators Survey
Form and Instruction 0920-0572 Health Care Providers Survey
Form and Instruction 0920-0572 Person with DM had DSMES Survey
Form and Instruction 0920-0572 Person with DM not had DSMES Survey
Message Testing for Food Safety Content New 280 130 0 Form and Instruction 0920-21DU Digital Screening Form
Form and Instruction 0920-21DU In-depth Interview
Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy New 416 283 0 Form and Instruction 092-21FM Attachment B-HCP QualBoard Screener-MD-NP-PA-MW
Form and Instruction 0920-21FM Attachment L-HCP QualBoard Discussion Guide
Form and Instruction 0920-21FM Attachment E-HCP IDI Screener-RN-MA
Form and Instruction 0920-21FM Attachment E-HCP IDI Discussion Guide -RN-MA
Form and Instruction 0920-21FM Attachment F-WRA QualBoard Screener
Form and Instruction 0920-21FM Attachment F-WRA QualBoard Discussion Board
Form and Instruction 0920-21FM Attachment G-WRA Focus Group Screener
Form and Instruction 0920-21FM Attachment O-WRA Focus Group Discussion Guide
Message Testing: Radiation Emergencies and Cancer Risk New 600 150 0 Form and Instruction 0920-0572 Message Testing Survey
Other-Online Screenshot
Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences New 696 186 0 Form and Instruction 0920-0572 Cancer Patients and Caregivers Mod Guide
Form and Instruction 0920-0572 Men Aged 65 and Older Mod Guide
Form and Instruction 0920-0572 Sepsis Survivors and Caregivers Mod Guide
Form and Instruction 0920-0572 Women Who Care for Aging Parent Mod Guide
Form and Instruction 0920-0572 Women Who Care for Child Mod Guide
Form and Instruction 0920-0572 Women Who Primarily Speak Spanish Mod Guide En
Form and Instruction 0920-0572 Cancer Patients Screener
Form and Instruction 0920-0572 Caregivers to Cancer Screener
Form and Instruction 0920-0572 Caregivers to Sepsis Survivors Screener
Form and Instruction 0920-0572 Men Aged 65 and Older Screener
Form and Instruction 0920-0572 Sepsis Survivors Screener
Form and Instruction 0920-0572 Women who Care for Aging Parent Screener
Form and Instruction 0920-0572 Women Who Care for Child Screener
Form and Instruction 0920-0572 Women Who Speak Spanish Screener (Eng)
Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs) New 225 64 0 Form and Instruction n/a Screening Form for Dentists
Form and Instruction n/a Screening Form for Hospitalists
Form and Instruction n/a Screening Form for Nurses in Nursing Homes
Form and Instruction n/a Screening Form for Community Pharmacists
Form and Instruction n/a Screening Form for Advanced Practice Providers and Physicians in Nursing Homes
Form and Instruction n/a Interviewer Guide for Dentists
Form and Instruction n/a Interviewer Guide for Hospitalists
Form and Instruction n/a Interviewer Guide for Nurses in Nursing Homes
Form and Instruction n/a Interviewer Guide for Community Pharmacists
Form and Instruction n/a Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes
NIOSH Manual of Analytical Methods Survey New 1000 417 0 Form and Instruction n/a NMAM Customer Satisfaction Survey
National Firefighter Registry New 2060 520 0 Other-WORd
Other-WORD
Other-WORD
Other-WORD
Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach New 336 106 0 Form and Instruction 0920-0572 Focus Group Screener
Form and Instruction 0920-0572 Focus Group Guide English
Form and Instruction 0920-0572 Focus Group Guide Spanish
Sexual Health Study for Gay and Bisexual Men New 460 93 0 Form and Instruction 0920-0572 Screener - Understanding Sexual Health Messaging among Men who have Sex with Men
Form and Instruction 0920-0572 Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men
Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults New 550 133 0 Form 0920-0572 Screener
Other-English translation
Form and Instruction 0920-0572 Handwashing Interview Guide
Other-English translation
Form and Instruction 0920-0572 Hand Sanitizer Interiview Guide
Other-English translation
Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults New 520 104 0 Form and Instruction 0920-0572 Interview Guide
Form and Instruction 0920-0572 Screening Form
Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults New 656 579 0 Form and Instruction n/a Screener and Focus Group Invitation
Form and Instruction n/a Focus Group Moderators Guide
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 29034 6703 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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