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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Study of Perceptions and Knowledge of Visually Depicted Health Conditions
Agency IC Tracking Number:
CTP
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
Other-Stimuli
Qual Study of Perceptions and Knowledge Depicted Health Conds_Addendum A - Stimuli.docx
No
Printable Only
Other-Adult Consent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form.docx
No
Printable Only
Other-Adult Consent Form - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form_Spanish.docx
No
Printable Only
Other-Interview Guide
Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide.docx
No
Printable Only
Other-Interview Guide - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide__Spanish.docx
No
Printable Only
Other-Parental Consent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form.docx
No
Printable Only
Other-Parental Consent Form - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form_Spanish.docx
No
Printable Only
Other-Screener Adults - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Adults_Spanish.docx
No
Printable Only
Other-Screener - Youth and Parent
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Youth and Parent.doc
No
Printable Only
Other-Screener Youth Parent - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - YouthParent_Spanish.docx
No
Printable Only
Other-Screener Adults
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener- Adults.doc
No
Printable Only
Other-Youth Assent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form.doc
No
Printable Only
Other-Youth Assent Form - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form_Spanish.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,426
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
1,426
0
1,426
0
0
0
Annual IC Time Burden (Hours)
168
0
168
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Memo
Depicted Health Conditions OMB Justification Memo.docx
09/11/2015
Supporting Statement Memo Updated Version
Depicted Health Conditions OMB Justification Memo_101415.docx
10/16/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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