Evaluation of a Prevention Information Prototype in the Context of a HRSA Community Health Center

Prevention Communication Formative Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0281 can be found here:

Documents and Forms

Document Name Document Type
Pre Survey_0990_0281_#10 (3).doc Other-survey
Post Survey_0990_0281_#10 (3).doc Other-survey
30 Day Follw up_0990_0281_#10 (3).doc Other-survey
OMB Memo 0990-0281_#10 (2).doc OMB Memo 0990-0281_#10 (2) IC Document

Information Collection (IC) Details

IC Title:	Evaluation of a Prevention Information Prototype in the Context of a HRSA Community Health Center	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	Pre Survey_0990_0281_#10 (3).doc	No	No	Paper Only
Other-survey	Post Survey_0990_0281_#10 (3).doc	No	No	Paper Only
Other-survey	30 Day Follw up_0990_0281_#10 (3).doc	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	0	0	0	0	0
Annual IC Time Burden (Hours)	117	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo 0990-0281_#10 (2)	OMB Memo 0990-0281_#10 (2).doc	07/10/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.