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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NCEZID] In-Depth Interviews with Young Adults About Emergency Response Communication
Agency IC Tracking Number:
0920-25-0151
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
n/a
Screener
Attch 1_NCEZID_Emergency Response Comm IDI Screener_v2_7.11.25.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Consent
Attch 2_NCEZID_Emergency Response Comm ID Consent Form_v2_7.11.25.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Interview Guide
Attch 3_NCEZID_Emergency Response Comm IDI_Guide_v2_7.11.25.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
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
120
0
120
0
0
0
Annual IC Time Burden (Hours)
19
0
19
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
NCEZID_Emergency Response Comm_OMB SSA_v1_7.11.25.docx
07/31/2025
SSB
NCEZID_Emergency Response Comm_OMB SSB_v1_7.11.25.docx
07/31/2025
Research Determination
Attch 4_Human Subjects Determination.pdf
07/31/2025
GenIC Request Template
NCEZID_Emergency Response Comm_GenIC Request Form_v1_7.11.25.docx
07/31/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.