View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Agency IC Tracking Number:

IC Status: Unchanged

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				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,950	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	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	5,950	0	0	0	0	5,950
Annual IC Time Burden (Hours)	2,406	0	0	0	0	2,406
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
African American HTMS Expedited Review Form		04/03/2013
African American Email Invitation and Reminders		04/03/2013
African American IRB Letter		04/03/2013
African American Consent		04/04/2013
Community Health HMTS Expedited Review Form		04/04/2013
Community Health Summary of Procedures		04/04/2013
Community Health Wave 1 Materials		04/08/2013
Community Health Wave 2 Materials		04/08/2013
Community Health Wave 3 Materials		04/08/2013
Community Health Wave 4 Materials		04/08/2013
Community Health Wave 1 Survey		04/08/2013
Community Health Wave 2 Survey		04/08/2013
Community Health Wave 3 Survey		04/08/2013
Community Health Wave 4 Survey		04/08/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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