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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Development of a Motion Comic for HIV/STI Prevention Among Young People Ages 15-24 Phase 2
Agency IC Tracking Number:
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
none
Motion Comic Pre Test Survey
Att_1d_Participant Pre-Test Survey.docx
Yes
Yes
Fillable Fileable
Form
none
Motion Comic Focus Group Guide 2
Att_1c_Round 2 Focus Group Modertor Guide.docx
Yes
No
Printable Only
Form
none
Motion Comic Screener
Att_1a_Study Screener.docx
Yes
Yes
Fillable Fileable
Form
none
Motion Comic Post Test Survey
Att_1e_Participant Post-Test Survey.docx
Yes
Yes
Fillable Fileable
Form
none
Motion Comic Focus Group Guide 1
Att_1b_Round 1 Focus Group Modertor Guide.docx
Yes
No
Printable Only
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:
540
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
540
0
0
0
0
0
Annual IC Time Burden (Hours)
275
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Motion Comic Part B
SS_Part B_ MotionComic 20MAR2013.docx
03/21/2013
Motion Comic Parent Consent
Att_2b_Adolescent Parent Consent.docx
03/21/2013
Motion Comic Adult Consent
Att_2a_Adult Consent.docx
03/21/2013
Motion Comic Adolescent Assent
Att_2c_Adolescent Assent.docx
03/21/2013
Motion Comic Recruitment Script
Att_4b_Recruitment Script.docx
03/21/2013
Motion Comic IRB Approval
Att_3a_CDC IRB Approval.docx
03/21/2013
Motion Comic Recruitment Flyer
Att_4a_Study Recruitment Flyer.docx
03/25/2013
Motion Comic Part A
SS_Part A_ Motion Comic 20MAR2013.docx
03/25/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.