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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)
Agency IC Tracking Number:
0920-1154-24BH
IC Status:
Unchanged
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
0920-1154
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Broadcast Radio
Attachment 1 - Survey Instrument -Broadcast radio.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1154
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Digital Ad
Attachment 2 - Survey Instrument -Digital Ad.docx
Yes
Yes
Fillable Fileable
Other-Screenshots - Broadcast Radio
Attachment 3 - Broadcast Radio Screenshots.docx
No
Paper Only
Other-Screenshots - Digital Ad
Attachment 4 - Digital Ad Survey Screenshots.docx
No
Printable Only
Instruction
Attachment 5 - Recruitment Materials.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,750
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
1,750
0
0
0
0
1,750
Annual IC Time Burden (Hours)
379
0
0
0
0
379
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
SSA_11.27.23.docx
11/27/2023
SSB
Supporting Statement B.docx
11/27/2023
Privacy Act Determination
Attachment 6 Privacy Act-Determination.pdf
11/27/2023
IRB Determination
Attachment 7. IRB Determination Letter.pdf
11/27/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.