Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CDC Older Adult Injury Prevention Creative Campaign - Survey New 500 84 0 Form and Instruction 0920-22EC Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002)
CDC Screen for Life Pretesting Focus Groups New 192 168 0 Form and Instruction 0920-0572 Screen For Life Focus Group Screener - English
Form and Instruction 0920-0572 Screen For Life Focus Group Screener - Spanish
Form and Instruction 0920-0572 Screen For Life Focus Group Consent - English
Form and Instruction 0920-0572 Screen For Life Focus Group Consent - Spanish
Form and Instruction 0920-0572 Screen For Life Focus Group Discussion Guide - English
Form and Instruction 0920-0572 Screen For Life Focus Group Discussion Guide - Spanlish
Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Formative Focus Group Research New 108 180 0 Form 0920-22JE Attachment B. Consumer Focus Group Participant Screener
Form and Instruction 0920-22JE Attachment C. Health Provider Focus Group Participant Screener
DNPAO Message and Materials Testing New 316 580 0 Form and Instruction 0920-22IZ Screener
Form and Instruction 0920-22IZ Discussion Guide
Dating Matters - Rebranding New 72 33 0 Form and Instruction 0920-22IO Att. 1_ DM FGD recruitment & Screening form
Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign New 250 62 0 Form and Instruction 0920-22FW Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed
Form and Instruction 0920-22FW Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed
Form and Instruction 0920-22FW Attachment 5. Appendix D. HCP Survey Instrument for Exposed
Form and Instruction 0920-22FW Attachment 6. Appendix E. HCP Survey Instrument for Unexposed
Health Equity Message Testing New 71 99 0 Form and Instruction 0920-0572 In-Depth Interviews: Communication Materials
Form and Instruction 0920-0572 Focus Groups: Communication Materials
Impact Evaluation Demonstration Project DDP/LCP New 805 110 0 Form and Instruction 0920-22DZ Attachment D. Screener and Survey
Form 0920-22DZ Attachment E. Survey Consent
Form 0920-22DZ Attachment G. Enrollment Log
Intimate Partner Violence / Sexual Violence Prevention Message Testing New 40 45 0 Other-Recruitment and Scheduling
Form and Instruction None Focus Group Discussion Guide
Message and Materials Testing to Expand Essentials for Parenting New 80 45 0 Form and Instruction 0920-22EZ Recruitment Screener
Form and Instruction 0920-22EZ Focus Group Discussion
PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS New 197 102 0 Form 0920-0572 Educational Video (script)
Form 0920-0572 B1 Your Health and Moving to the United States
Form 0920-0572 B2 Moving to the United States and Your Health
Form 0920-0572 B1 Applicant Intercept Interview Guide
Form 0920-0572 B1 Applicant Consent Script (Chest X-Ray)
Form 0920-0572 B2 Applicant Consent Script (Child's Blood Test)
Form 0920-0572 Clinic Staff In-depth Interview Consent Script
Form 0920-0572 In-depth Interview Guide
Form 0920-0572 B1 Client Recruitment Script
Form 0920-0572 B2 Client Recruitment Script
Form 0920-0572 B1 Client Screener
Form 0920-0572 B2 Client Screener
Sexual health communication among young adults. New 1000 200 0 Form and Instruction 0920-22FQ B.DSTDP_sexual comms young adults_Informed consent_Screener_Questionnaire
Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) New 600 260 0 Form and Instruction 0920-0572 Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Survey
Form and Instruction 0920-0572 Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Screener
Tick- and Mosquito-borne Disease Prevention Message Evaluation New 180 97 0 Form and Instruction 0920-0572 Focus Group Screening Form
Form and Instruction 0920-0572 Focus Group Invitation
Form and Instruction 0920-0572 Focus Group Discussion Guide
[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials New 2087 627 0 Form 0920-20572 Screener (24CQ)
Form and Instruction 0920-0572 Consent Form Main Sample (24CQ)
Form and Instruction 0920-0572 Consent Form Tribal Sample (24CQ)
Form and Instruction 0920-0572 Baseline Survey (24CQ)
Instruction
Instruction
Form 0920-0572 Weekly Surveys Treatment Group (24CQ)
Form 0920-0572 Weekly Surveys Control Group (24CQ)
Instruction
Form 0920-0572 Follow-Up Survey (24CQ)
Form 0920-0572 Tribal Survey (24CQ)
Instruction
Form and Instruction 0920-0572 Baseline Survey (24CQ) Edited
Form 0920-0572 Tribal Survey (24CQ) Edited
[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing New 7425 1725 0 Form and Instruction 0920-0572 Screener for Physical Activity Ads Survey
Form and Instruction 0920-0572 Screener for Sugary Drinks Ads Survey
Form and Instruction 0920-0572 Screener for Infant and Toddler Nutrition Ads Survey
Form and Instruction 0920-0572 Survey for Physical Activity Ads
Form and Instruction 0920-0572 Survey for Sugary Drinks Ads
Form and Instruction 0920-0572 Survey for Infant and Toddler Nutrition Ads
[OADC] Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Material Testing New 2800 700 0 Form and Instruction 0920-0572 CDC Inside Knowledge Message Testing
Other-WORD version
Form and Instruction 0920-0572 Programmed Message Test Online Version (24GY)
Other-WORD version
[OADC] DSMES Playbook Survey at ADCES Exhibit Hall New 200 7 0 Other-WORD version
Form 0920-0572 ADCES Exhibit Hall Playbook Survey
[OADC] Developing and Testing New Infographics for Health Equity New 1200 480 0 Form 0920-0572 General Population Screening Questionnaire
Form and Instruction 0920-0572 Screening Questionnaire
Form and Instruction 0920-0572 General Population Quantitative Testing Instrument
Form and Instruction 0920-0572 Public Health Professionals Quantitative Testing Instrument
Form 0920-0572 Qualitative Focus Group Discussion Guide – All Audiences
[OADC] Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing New 400 675 0 Form and Instruction 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Screener (24FF)
Form and Instruction 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Interview Guide (24FF)
Form and Instruction 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Small Group Discussion Guide (24FF)
[OADC] Formative Evaluation to Assess the Effectiveness of Excessive Alcohol Use Prevention Messages - Public Health Stakeholder Focus Groups New 150 87 0 Form 0920-23DS Attachment 8_Online Panel Survey_FINAL (002)
Form 0920-23DS Attachment 4_Focus Group Consent Form_FINAL
[OADC] HEADS UP! Parents Messaging Concussion Care Message Materials Testing New 216 74 0 Form and Instruction 0920-23CH Attachment C_FGD screener
[OADC] In Depth Interviews with Obstetric Nurses and Obstetric Nurse Practitioners to Test Hear Her Campaign Materials New 108 33 0 Form and Instruction 0920-23HZ Interview Guide
Form and Instruction 0920-23HZ Screening/Interview Guide
[OADC] Infant Feeding Message Testing in Radiation Emergencies New 220 96 0 Form and Instruction n/a Infant Feeding Screening Instrument
Form and Instruction n/a Infant Feeding Moderators Guide
Other-Info Sheet
[OADC] One Health Office Healthy Pets, Healthy People Message Testing New 90 90 0 Other-WORD
[OADC] Still Going Strong Campaign Expansion Pilot Testing Survey New 1400 128 0 Form and Instruction n/a Survey Invitation
Form and Instruction n/a General Older Adults Survey
Form and Instruction n/a Tribal Elders Survey
[OC] DCPC Screen for Life New 1050 105 0 Form and Instruction 0920-0572 Recruitment Language - English
Form and Instruction 0920-0572 Recruitment Language - Spanish
Form and Instruction 0920-0572 Screener - English_paper
Form and Instruction 0920-0572 Screener - English_online
Form and Instruction 0920-0572 Screener - Spanish_paper
Form and Instruction 0920-0572 Screener - Spanish_online
Form and Instruction 0920--0572 Informed Consent - English
Form and Instruction 0920-0572 Informed Consent - Spanish
Form and Instruction 0920-0572 Questionnaire-English_paper
Form and Instruction 0920-0572 Questionnaire-English_online
Form and Instruction 0920-0572 Questionnaire-Spanish_paper
Form and Instruction 0920-0572 Questionnaire-Spanish_online
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 21757 6892 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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