View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Message Testing for the AAA Campaign - Hispanics/Latinos	Agency IC Tracking Number:

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
Form and Instruction	0920-0920	Message Testing for the AAA Campaign - Hispanics/Latinos	Attachment 1A_Web-based Survey_Spn.docx		Yes	Yes	Fillable Printable
Form and Instruction	0920-0920	Attachment 2_Web-based Screener_Eng	Attachment 2_Web-based Screener_Eng.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0920	Attachment 1 Message Testing for the AAA Campaign - HispanicsLatinos	Attachment 1 Message Testing for the AAA Campaign - HispanicsLatinos.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0920	Attachment 2A_Web-based Screener_Spn	Attachment 2A_Web-based Screener_Spn.docx		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: 1,170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	1,170	0	0	0	0	0
Annual IC Time Burden (Hours)	272	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A.docx	09/26/2013
Supporting Statement B	Supporting Statement B.docx	09/26/2013
Attachment 3_Consent_Eng	Attachment 3_Consent_Eng.docx	09/26/2013
Attachment 3A_Consent_Spn	Attachment 3A_Consent_Spn.docx	09/26/2013
Attachment 4_Reminder Email_Eng	Attachment 4_Reminder Email_Eng.docx	09/26/2013
Attachment 4A_Reminder Email_Span	Attachment 4A_Reminder Email_Span.docx	09/26/2013
Attachment 5 Creative for Web	Attachment 5 Creative for Web.pdf	09/26/2013
Attachment 6 CampaignMessages-WebSurvey	Attachment 6 CampaignMessages-WebSurvey.docx	09/26/2013
CONCEPTS FOR OMB APPROVAL	CONCEPTS FOR OMB APPROVAL.pdf	09/26/2013

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