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

View Information Collection (IC)

Formative Research for Spanish-Language Drug Overdose Messages
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Qualitative Eligibility Screener (Phone) Attachment 1.1_ Qualitative Eligibility Screener (Phone)_final.docx No   Fillable Fileable
Form and Instruction n/a Qualitative Eligibility Screener (Online) Attachment 1_ Qualitative Eligibility Screener (Online)_final.docx Yes Yes Fillable Fileable
Form and Instruction n/a Focus Group Moderator Guide Attachment 2 - Focus Group Moderator Guide-9.2_final.docx Yes Yes Fillable Fileable
Form and Instruction n/a Interview Guide Attachment 3 - Interview Guide 1-30_final.docx Yes No Fillable Fileable
Form and Instruction n/a Online Survey Attachment 4 - Online Survey_final.docx Yes Yes Fillable Fileable
Form and Instruction n/a Respondent Consent Form and Participants Email Attachment 6 - Respondent Consent Form and Participants email_final.docx Yes Yes Fillable Fileable
Instruction Attachment 7 - Follow Up Email for Qualitative Data Collection and Survey_final.docx No   Fillable Fileable
Instruction Attachment 8 - Recruitment Materials_FINAL_final.docx Yes No Fillable Fileable

Health Public Health Monitoring

 

4,726 0
   
Individuals or Households
 
   90 %

  Requested 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 4,726 0 0 0 0 4,726
Annual IC Time Burden (Hours) 447 0 0 0 0 447
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA SSA_Formative Research Spanish DO Messages 1-30 CLEAN_final.docx 03/16/2023
Zoom Poll Example Attachment 2.1 Zoom Poll Example.png 03/16/2023
Privacy Assessment Attachment 5_Spanish Message Testing_PIA.pdf 03/16/2023
Privacy Agreement Attachment 5.1- Privacy Agreement 9.2.docx 03/16/2023
Follow Up Message for Survey Collection Attachment 9 - Follow Up Message for Survey Collection 9.2.docx 03/16/2023
Messages and Materials for Testing Attachment 10 - Messages and Materials for Testing 9.2.docx 03/16/2023
Recruitment Materials Attachment 11 - Recruitment Materials 9.2.docx 03/16/2023
Research Determination Attachment 12 - DOCR_IRB Determination 9.2.pdf 03/16/2023
GenIC Request Template GenIC Request_Formative Research Spanish DO Messages 10.4_final.docx 03/16/2023
Online Survey Screenshots Fentanyl and Naloxone Attachment 4.1 Online Survey Screenshots Fentanyl and Naloxone.pdf 03/16/2023
Online Survey Screenshots Stigma and Polysubstance Use Attachment 4.2 Online Survey Screenshots Stigma and Polysubstance Use.pdf 03/16/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.