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

Asthma Control Communication Materials Field Testing (NCEH) 0920-0572-18QD
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Foduc Group Screener Attachment 1_Focus Group Screener.docx Yes No Paper Only
Other-Discussion Guide Attachment 2_Focus Group Discussion Guide.docx Yes No Paper Only
Form and Instruction none Youth Rating Worksheet Attachment 3_Focus Group Rating Worksheet_Youth.docx Yes No Paper Only
Form and Instruction none Caregiver Rating Worksheet Attachment 4_Focus Group Rating Worksheet_Caregiver.docx Yes No Paper Only
Form and Instruction none Youth Comparison Worksheet Attachment 5_Focus Group Comparison Worksheet_Youth.docx Yes No Paper Only
Form and Instruction none Caregiver Comparison Worksheet Attachment 6_Focus Group Comparison Worksheet_Caregiver.docx Yes No Paper Only

Health Illness Prevention

 

448 0
   
Individuals or Households
 
   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 448 0 448 0 0 0
Annual IC Time Burden (Hours) 128 0 128 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HTMS Review Form HMTSExpeditedReviewForm_Asthma Control Communication Materials Field Testing.pdf 02/20/2018
Project Description PrjctDscrptn_Asthma Control Communication Materials Field Testing.docx 02/20/2018
Youth Assent Attachment 8_Focus Group Youth Assent Form.docx 02/20/2018
Caregiver Permission for Youth Attachment 7_Focus Group Caregiver for Youth Permission Form.docx 02/20/2018
Caregiver Consent Attachment 9_Focus Group Caregiver Consent Form.docx 02/20/2018
Fogus Group Confirmation Email Attachment 10_Focus Group Confirmation Email.docx 02/20/2018
Focus Group Reminder Email Attachment 11_Focus Group Reminder Email.docx 02/20/2018
Focus Group Message Stimuli Attachment 12_Focus Group Message Stimuli.pptx 02/20/2018
List of Attachments List of Attachments.docx 02/20/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.