View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Rough Cut Testing of Spanish Language Television, Print, Digital Print, and Radio Ads for the Tips 2014 National Campaign
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none 1a - Screener - Spanish Att 1a Screener (Spanish) 03112013.docx Yes Yes Fillable Fileable
Form none 1b - Questionnaire - Spanish Att 1b Main Questionnaire (Spanish) 03112014.docx Yes Yes Fillable Fileable
Form none 5 - Screenshots of questionnaire Att 5_Screenshots SPANISH.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

7,448 0
   
Individuals or Households
 
   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 7,448 0 0 0 0 0
Annual IC Time Burden (Hours) 1,672 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A GenIC 10_Part A_03202014.docx 03/24/2014
Supporting Statement B GenIC 10_Part B_03202014.docx 03/24/2014
1a - Screener - English Att 1a Screener (English).docx 03/24/2014
1b - Questionnaire - English Att 1b Main Questionnaire (English).docx 03/24/2014
2 - Email Recruitment Att 2_Email Recruitment (Spanish).docx 03/24/2014
3 - Privacy Policy Att 3_Privacy Policy (Spanish).docx 03/24/2014
4 - Terms and Conditions Att 4_Terms and Conditions (Spanish).docx 03/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.