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

View Information Collection (IC)

[2022] Select Adapt Evaluate - VetoViolence Usability Testing 0920-22EP
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Recruitment Materials Att 2_Recruitment Materials_04252022.docx Yes Yes Fillable Printable
Form and Instruction None Screening Form Att 3_Screening Form_04252022.docx Yes Yes Fillable Printable
Form and Instruction None Interview Scheduling Att 4_Follow Up Email to Schedule Interview_04252022.docx Yes Yes Fillable Printable
Form and Instruction None Consent and Interview Guide Att 5_Informed Consent and Interview Guide_04252022.docx Yes Yes Fillable Printable

Health Consumer Health and Safety

 

12 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 12 0 12 0 0 0
Annual IC Time Burden (Hours) 15 0 15 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GENIC Template with Project Description (Select Adapt Evaluate) OMB Generic_Customer Satisfaction_VetoViolence Select Adapt Evaluate.docx 04/25/2022
CDC Determination: The Privacy Act does not apply Att 1. Privacy Applicability Determination.pdf 04/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.