View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing
Agency IC Tracking Number:
0920-0572-23HJ
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
Screener for Physical Activity Ads Survey
Attachment C1 Screener for Physical Activity Ads Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screener for Sugary Drinks Ads Survey
Attachment D1 Screener for Sugary Drinks Ads Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Screener for Infant and Toddler Nutrition Ads Survey
Attachment E1 Screener for Infant and Toddler Nutrition Ads Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Survey for Physical Activity Ads
Attachment C2 Survey for Physical Activity Ads.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Survey for Sugary Drinks Ads
Attachment D2 Survey for Sugary Drinks Ads.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Survey for Infant and Toddler Nutrition Ads
Attachment E2 Survey for Infant and Toddler Nutrition Ads.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
7,425
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
7,425
0
7,425
0
0
0
Annual IC Time Burden (Hours)
1,725
0
1,725
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
List of attachments to HMTS Expedited Review Form
ATTACHMENT A- Supplement to HMTS Expedited Review - SCHMC Ad Testing 2023 ( revised 5-9-23).docx
08/04/2023
Ads to be tested
ATTACHMENT B-Ads to be tested - SCHMC Ad Testing 2023- 3-30-23.docx
08/04/2023
Screen Captures of Screener and Survey for Physical Activity Ads
Attachment C3 Screen Captures of Screener and Survey for Physical Activity Ads.docx
08/09/2023
Screen Captures of Screener and Survey for Sugary Drinks Ads
Attachment D3 Screen Captures of Screener and Survey for Sugary Drinks Ads.docx
08/09/2023
Screen Captures of Screener and Survey for Infant and Toddler Nutrition Ads
Attachment E3 Screen Captures of Screener and Survey for Infant and Toddler Nutrition Ads.docx
08/09/2023
HMTS Expedited Review Form
HMTS Form- SCHMC Ad Testing 2023- rev 5-9-2023.docx
08/09/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.