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A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women 0920-0572-21HV
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 Focus Group Recruitment Script and Screener Attachment 2_Focus Group Recruitment Script and Screener_17June2021.docx No   Paper Only
Form 0920-0572 Focus Group Discussion Guide Attachment 3_Focus Group Moderator Guide_17June2021.docx No   Paper Only
Other-Password Protected file Current Hear Her Campaign Materials1.pdf No   Fillable Fileable
Other-Password Protected file Hear Her AI AN Testing Materials1.pdf No   Fillable Fileable

Health Public Health Monitoring

 

272 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 272 0 272 0 0 0
Annual IC Time Burden (Hours) 115 0 115 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Background Informatino Attachment 1_Background Information_23June2021.docx 08/25/2021
Consent Form Attachment 4_Consent Form for Focus Group Participation_23June2021 (002).docx 08/25/2021
Email Notification Script Attachment 5_Notification Scripts_16June2021.docx 08/25/2021
HMTS Review Form _ AIAN Women HMTS~G(N.PDF 08/25/2021
Video Concept Clearance 311241 Video Concept Clearance 311241.msg 08/25/2021
List of Attachments List of Attachments.docx 08/25/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.