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View Information Collection (IC)
View Information Collection (IC)
IC Title:
CDC Screen for Life Pretesting Focus Groups
Agency IC Tracking Number:
0920-0572-22GK
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-0572
Screen For Life Focus Group Screener - English
2A CDC SFL FG Screener ENGLISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screen For Life Focus Group Screener - Spanish
2B CDC SFL FG Screener SPANISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screen For Life Focus Group Consent - English
4A CDC SFL FG Informed Consent ENGLISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screen For Life Focus Group Consent - Spanish
4B CDC SFL FG Informed Consent SPANISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screen For Life Focus Group Discussion Guide - English
5A CDC SFL FG Discussion Guide ENGLISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screen For Life Focus Group Discussion Guide - Spanlish
5B CDC SFL FG Discussion Guide SPANISH 052522.docx
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
192
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
192
0
192
0
0
0
Annual IC Time Burden (Hours)
168
0
168
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screen For Life Focus Group Emails - English
3A CDC SFL FG Emails ENGLISH 052522.docx
06/24/2022
Screen For Life Focus Group Emails - Spanlish
3B CDC SFL FG Emails SPANISH 052522.docx
06/24/2022
Screen For Life Focus Group Thank You Email - English
6A CDC SFL FG Thank You Email ENGLISH 052522.docx
06/24/2022
Screen For Life Focus Group Thank You Email - Spanish
6B CDC SFL FG Thank You Email SPANISH 052522.docx
06/24/2022
Messages to be Tested - StoryBoards_English
SFL _ Storyboards.pdf
06/24/2022
Messages to be Tested - StoryBoards_Spanish
SFL _ Storyboards - Spanish (04_28).pdf
06/24/2022
Screen For Life - Background Information
1 CDC SFL FG Background Information 052522.docx
06/24/2022
Health Message Testing System (HMTS) Expedited Review Form
HMTSExpeditedReviewForm_032322.pdf
06/24/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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