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

View Information Collection (IC)

Connecting the Dots Across Injury Prevention Bullying and Substance Use Prevention Message Testing  0920-22DY
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Screener for Parents and Caregivers 1_ Parents_Caregivers_Screener_updated3_05092022.docx Yes Yes Fillable Printable
Form and Instruction None Recruitment Emails for Practitioners Attachment 2_ Practitioner Recruitment Emails.docx Yes Yes Fillable Printable
Form and Instruction None Parent and Caregiver Focus Group Discussion Guide Attachment 3_Parents and Caregivers FGD Guide.docx Yes Yes Fillable Printable
Form and Instruction None Bullying Prevention Practitioner Focus Group Discussion Guide Attachment 4_Bullying Practitioners FGD Guide.docx Yes Yes Fillable Printable
Form and Instruction None Substance Use Prevention Practitioner Focus Group Discussion Guide Attachment 5_Substance Use Prevention_v2.docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

64 0
   
Individuals or Households
 
   100 %

  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 64 0 64 0 0 0
Annual IC Time Burden (Hours) 71 0 71 0 0 0
Annual IC Cost Burden (Dollars) 1,949 0 1,949 0 0 0

Title Document Date Uploaded
Supporting Statement Part A SSA _Connecting the Dots_05092022v2.docx 05/09/2022
Supporting Statement Part B Supporting Statement B (0920-1154) Connecting the Dots.docx 05/09/2022
Sample Message Presentation Slides for Parent/Caregiver Focus Groups Attachment 6_Parent Caregiver Sample Message Presentation Slides.pptx 05/09/2022
Sample Message Presentation Slides for Practitioner Focus Groups Attachment 7_Practitioner Sample Message Presentation Slides.pptx 05/09/2022
CDC Determination: The Privacy Act does not apply PIA_Connecting the dots.pdf 05/09/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.