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

HEADS UP! Parents Feedback 0920-1154-22CQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Recruitment Materials Att. 5 Recruitment.docx No   Fillable Fileable
Form and Instruction 0920-1154 Screening Form Att. 3 Audience Research Screening form.docx Yes Yes Fillable Fileable
Other-Email Att. 7 Follow-up email.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Focus Group Discussion Guide and Consent Att. 1 FGD Guide and Consent.docx Yes No Fillable Fileable

Health Public Health Monitoring

 

708 0
   
Individuals or Households
 
   90 %

  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 708 0 708 0 0 0
Annual IC Time Burden (Hours) 108 0 108 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A Supporting Statement A (0920-1154) HEADS UP_final.docx 02/07/2022
Supporting Statement B Supporting Statement B (0920-1154) HEADS UP_final.docx 02/07/2022
Recruitment Materials Spanish Att. 6 Recruitment_FT-es-US_final.docx 02/07/2022
Screening Form Spanish Att. 4 Audience Research Screening form-es-US_final.docx 02/07/2022
Email Spanish Att. 8 Follow-up email-es-US_final.docx 02/07/2022
Focus Group Discussion Guide and Consent Spanish Att. 2 FGD Guide and Consent-es-US_final.docx 02/07/2022
PIA Att 9a_ PIA HEADS UP.pdf 02/07/2022
Project Determination Att. 9 Project Determination_final.docx 02/07/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.