View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Development of Messages for the Act Against AIDS National Testing Campaign	Agency IC Tracking Number:	15MG

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	none	Development of Messages Survey	Att 2_Web-Based Survey.docx		Yes	Yes	Fillable Fileable
Form	none	Development of Messages Survey - screenshots	Att 2a_New National Screen Shots.pdf		Yes	Yes	Fillable Fileable
Form	none	Screener	Att 3_Web-Based Screener.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,744	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	3,744	0	3,744	0	0	0
Annual IC Time Burden (Hours)	871	0	871	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-Clean.docx	06/17/2015
Supporting Statement B	Supporting Statement B.docx	06/17/2015
Consent	Att 4_Consent.docx	06/17/2015
Email Notification	Att 5_Email Reminder.docx	06/17/2015
Messages	Concepts.pdf	06/17/2015
Table Shells	Table shells_Web Survey_OMB_2015-2-24.docx	06/17/2015

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