Health Marketing

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Focus group question schedule	Form	New	Available
Innovator - Interview guide	Form	New	Available
Innovator - Consent form	Form	New	Available
Women consumers - Demographic questionnaire	Form	New	Available
Women consumers - Focus group guide	Form	New	Available
Women consumers - Consent form	Form	New	Available
Women consumers - Screener	Form	New	Available
Couples - Consent form	Form	New	Available
Couples -screener	Form	New	Available
Couples - Interview guide	Form	New	Available
Focus Group about Cigarette Smoking during Pregnancy - consent	Form	New	Available
Focus Group about Cigarette Smoking during Pregnancy - screener	Form	New	Available
Focus Group about Cigarette Smoking during Pregnancy - participant questionnaire	Form	New	Available
Focus Group about Cigarette Smoking during Pregnancy - focus group guide	Form	New	Available
KAB for Antibiotic Use - discussion guides	Form	New	Available
KAB for Antibiotic Use - screener	Form	New	Available
KAB for Antibiotic Use - prescreener	Form	New	Available
Focus Group about Women's Perception of Down Syndrome - consent	Form	New	Available
Focus Group about Women's Perception of Down Syndrome - questionnaire	Form	New	Available
Focus Group about Women's Perception of Down Syndrome - screener	Form	New	Available
Focus Groups about Women's Perception of Down Syndrome - focus group guide	Form	New	Available
AA STD Disparities - Triad and Interview Screener	Form	New	Available
AA STD DIsparities - Participant Domain Assessment	Form	New	Available
AA STD Disparities - Demographic and Behavioral Questionnaire	Form	New	Available
AA STD Disparities - Phase II Interview Guide for Individuals	Form	New	Available
AA STD Disparities - Phase I Interview Guide for Individuals	Form	New	Available
AA STD Disparities -Phase I Interview Guide for Triads	Form	New	Available
Emergency Risk Communication Network Needs Assessment	Form	New	Available
Consent Form	Form	New	Available
Screening Instrument	Form	New	Available
Participant Questionnaire	Form	New	Available
Focus Group Guide	Form	New	Available
CDC and NCHS User Survey	Form	New	Available
Public Health Law News questionnaire	Form	New	Available
IRBExemption.pdf	Supplementary Document	Uploaded 2008-07-21	Available
60dayFRN.pdf	Supplementary Document	Uploaded 2008-07-21	Available
AuthLegislation.pdf	Supplementary Document	Uploaded 2008-07-21	Available
OMB Generic Clearance Survey Questions.doc	Supplementary Document	Uploaded 2008-07-21	Available
HealthMarketingPartA.doc	Supporting Statement A	Uploaded 2008-07-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193927	Science to Practice: Developing and Testing a Marketing Strategy for Preventing Alcohol-related Problems in College Communities	Form	New	Focus group question schedule
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Innovator - Interview guide
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Innovator - Consent form
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Women consumers - Demographic questionnaire
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Women consumers - Focus group guide
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Women consumers - Consent form
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Women consumers - Screener
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Couples - Consent form
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Couples -screener
193776	Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	Form	New	Couples - Interview guide
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Cigarette Smoking during Pregnancy - consent
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Cigarette Smoking during Pregnancy - screener
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Cigarette Smoking during Pregnancy - participant questionnaire
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Cigarette Smoking during Pregnancy - focus group guide
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	KAB for Antibiotic Use - discussion guides
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	KAB for Antibiotic Use - screener
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	KAB for Antibiotic Use - prescreener
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Women's Perception of Down Syndrome - consent
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Women's Perception of Down Syndrome - questionnaire
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Group about Women's Perception of Down Syndrome - screener
192429	KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	Form	New	Focus Groups about Women's Perception of Down Syndrome - focus group guide
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD Disparities - Triad and Interview Screener
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD DIsparities - Participant Domain Assessment
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD Disparities - Demographic and Behavioral Questionnaire
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD Disparities - Phase II Interview Guide for Individuals
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD Disparities - Phase I Interview Guide for Individuals
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	AA STD Disparities -Phase I Interview Guide for Triads
192323	African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form	New	Emergency Risk Communication Network Needs Assessment
191180	Focus Groups about Alcohol Consumption during Pregnancy	Form	New	Consent Form
191180	Focus Groups about Alcohol Consumption during Pregnancy	Form	New	Screening Instrument
191180	Focus Groups about Alcohol Consumption during Pregnancy	Form	New	Participant Questionnaire
191180	Focus Groups about Alcohol Consumption during Pregnancy	Form	New	Focus Group Guide
190595	National Adult Tobacco Survey Questionnaire	Other-Telephone Survey	New
190102	National Center for Health Statistics Customer Satisfaction Survey of Website Users	Form	New	CDC and NCHS User Survey
188546	CDC Public Health Law News Collection of Assessment Information	Form	New	Public Health Law News questionnaire

ICR Details

OMB Control No: 0920-0798	ICR Reference No: 200807-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Health Marketing
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/08/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/30/2008
Terms of Clearance: Approved consistent with the following terms of clearance: OMB approves the requested generic for two years after which time CDC may resubmit and OMB will review the collection to assess the appropriateness of continuing the approval; approved for purposes of survey/informative materials development and customer satisfaction surveys only; all requests under this clearance must be individually submitted to and approved by OMB prior to fielding; OMB will generally review such requests within ten business days; OMB reserves the right to deny approval of requests under this generic for any reason.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved
Responses	86,000	0	0
Time Burden (Hours)	38,700	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's National Center for Health Marketing is requesting a 3-year approval for the generic concept of health marketing to provide feedback on the development, implementation and satisfaction regarding public health services, products, communication campaigns and information.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 27833	05/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 43241	07/24/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	none, none, none, none, none, none, none	Emergency Risk Communication Network Needs Assessment ,   AA STD Disparities -Phase I Interview Guide for Triads ,   AA STD Disparities - Phase I Interview Guide for Individuals ,   AA STD Disparities - Phase II Interview Guide for Individuals ,   AA STD Disparities - Demographic and Behavioral Questionnaire ,   AA STD DIsparities - Participant Domain Assessment ,   AA STD Disparities - Triad and Interview Screener
CDC Public Health Law News Collection of Assessment Information	none	Public Health Law News questionnaire
Focus Groups about Alcohol Consumption during Pregnancy	none, none, none, none	Focus Group Guide ,   Participant Questionnaire ,   Screening Instrument ,   Consent Form
Formative Research with Consumers, Couples, and Innovators about Reproductive Life Planning and Preconception Health	none, none, none, none, none, none, none, none, none	Couples - Interview guide ,   Couples -screener ,   Couples - Consent form ,   Women consumers - Screener ,   Women consumers - Consent form ,   Women consumers - Focus group guide ,   Women consumers - Demographic questionnaire ,   Innovator - Consent form ,   Innovator - Interview guide
KAB for Antibiotic Use, Focus Groups about Down Syndrome, and Focus Groups about CigaretteSmoking and Birth Defects	none, none, none, none, none, none, none, none, none, none, none	Focus Groups about Women's Perception of Down Syndrome - focus group guide ,   Focus Group about Women's Perception of Down Syndrome - screener ,   Focus Group about Women's Perception of Down Syndrome - questionnaire ,   Focus Group about Women's Perception of Down Syndrome - consent ,   KAB for Antibiotic Use - prescreener ,   KAB for Antibiotic Use - screener ,   KAB for Antibiotic Use - discussion guides ,   Focus Group about Cigarette Smoking during Pregnancy - focus group guide ,   Focus Group about Cigarette Smoking during Pregnancy - participant questionnaire ,   Focus Group about Cigarette Smoking during Pregnancy - screener ,   Focus Group about Cigarette Smoking during Pregnancy - consent
National Adult Tobacco Survey Questionnaire
National Center for Health Statistics Customer Satisfaction Survey of Website Users	none	CDC and NCHS User Survey
Science to Practice: Developing and Testing a Marketing Strategy for Preventing Alcohol-related Problems in College Communities	none	Focus group question schedule

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	86,000	0	0	86,000	0	0
Annual Time Burden (Hours)	38,700	0	0	38,700	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new generic ICR.

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Annual Cost to Federal Government: $5,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/30/2008

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