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

View Information Collection (IC)

High Impact Prevention Message Testing (HIPMT) 16AOS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Consumer Focus Group Guide Att 2A Consumer Focus Group Guide.docx NA No   Paper Only
Form and Instruction NA Consumer IDI Guide Att 2B Consumer IDI Guide.docx NA No   Paper Only
Form and Instruction NA Provider Focus Group Guide Att 3A Provider Focus Group Guide.docx NA No   Paper Only
Form and Instruction NA Provider IDI Guide Att 3B Provider IDI Guide.docx NA No   Paper Only
Form and Instruction NA Professional Focus Group Guide Att 4A Professional Focus Group Guide.docx NA No   Paper Only
Form and Instruction NA Professional IDI Guide Att 4B Professional IDI.DOCX NA No   Paper Only
Form and Instruction NA Consumer - Brief Survey Att 6 Brief survey - Consumer IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Provider - Brief Survey Att 7 Brief Survey - Provider IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Professional - Brief Survey Att 8 Brief Survey - Professional IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Consumer - Screener Att 10 Screener Consumer IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Provider - Screener Att 11 Screener Provider IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Professional - Screener Att 12 Screener Professional IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Consumer - Consent Att 14 Consent Consumer IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Provider - Consent Att 18 Consent Provider IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Professional - Consent Att 16 Consent Professional IDI FG.DOCX NA No   Paper Only
Form and Instruction NA Consumer Web Survey Att 9 Consumer Web Survey.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Intercept Guide Att 5 Intercept Guide.docx NA No   Paper Only
Form and Instruction NA Screener - Consumer Web Survey Att 13 Screener Consumer Web Survey.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Consent - Consumer Web Survey Att 13 Screener Consumer Web Survey.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Consent - Intercept Survey Att 17 Consent Intercept.docx NA No   Paper Only

Health Consumer Health and Safety

 

900 0
   
Individuals or Households
 
   45 %

  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 900 0 900 0 0 0
Annual IC Time Burden (Hours) 692 0 692 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Consumer Web Survey Email Notification Att 19 Web Survey Consumer E-mail Notification.docx 06/09/2016
Intercept Interview Receipt Form Att 20 Intercept Receipt Form.docx 06/09/2016
HIPMT Messages to be Tested Att 23 Messages to Test.docx 06/09/2016
Incentive Justification - Revised Att 21 Justification for Incentives_Revised 09JUN2016.docx 06/09/2016
HMTS - Expedited Review Form Revised HMTS Expedited Review Form_HIPMT-revised 09JUN2016.pdf 06/09/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.