Information Collection

Focus Groups and Intercept Interviews for Message and Materials Pretesting

IC 189989 under ICR 200901-0925-005 · OMB 0925-0585.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0585 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Focus Groups and Intercept Interviews for Message and Materials Pretesting	Form
1 Focus Groups Moderator Guide Appendix 1 Focus Group Moderators Guide.DOC	Form
2 Intercept Interview Appendix 2 Intercept Interview Instrument.DOC	Form and Instruction
3 Focus Group Screener Appendix 4 Focus Group Screener.DOC	Form and Instruction
Mini Supporting Statement 0925-0585-04.DOCX Mini Supporting Statement 0925-0585-04	IC Document
OMB Cover Letter 0925-0585-04.DOCX OMB Cover Letter 0925-0585-04	IC Document
Generic Clearance Form 0925-0585-04.DOCX Generic Clearance Form 0925-0585-04	IC Document
Appendix 3 AED Guidelines for Data Security.doc Appendix 3 AED Guidelines for Data Security	IC Document
Appendix 5 Notification of Privacy Act.doc Appendix 5 Notification of Privacy Act	IC Document
Appendix 6 Focus Group Informed Consent.doc Appendix 6 Focus Group Informed Consent	IC Document
Appendix 7 Intercept Interview Informed Consent.doc Appendix 7 Intercept Interview Informed Consent	IC Document
Appendix 8 IRB Exemption Review.doc Appendix 8 IRB Exemption Review	IC Document
Appendix 2 Intercept Interview Instrument Revised 09-0918.doc Appendix 2 Intercept Interview Instrument Revised	IC Document
Appendix 4 Focus Group Screener Revised 09-0918.doc Appendix 4 Focus Group Screener Revised	IC Document
Mini Supporting Statement 0925-0585-04 Revised 09-0918.docx Mini Supporting Statement 0925-0585-04 Revised	IC Document

IC Title:

Focus Groups and Intercept Interviews for Message and Materials Pretesting

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Focus Groups Moderator Guide	Appendix 1 Focus Group Moderators Guide.DOC	Yes	No	Paper Only
Form and Instruction	2	Intercept Interview	Appendix 2 Intercept Interview Instrument.DOC	Yes	Yes	Paper Only
Form and Instruction	3	Focus Group Screener	Appendix 4 Focus Group Screener.DOC	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 377

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	377	0	0	0	0	0
Annual IC Time Burden (Hours)	220	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini Supporting Statement 0925-0585-04	Mini Supporting Statement 0925-0585-04.DOCX	07/13/2009
OMB Cover Letter 0925-0585-04	OMB Cover Letter 0925-0585-04.DOCX	07/13/2009
Generic Clearance Form 0925-0585-04	Generic Clearance Form 0925-0585-04.DOCX	07/13/2009
Appendix 3 AED Guidelines for Data Security	Appendix 3 AED Guidelines for Data Security.doc	07/13/2009
Appendix 5 Notification of Privacy Act	Appendix 5 Notification of Privacy Act.doc	07/13/2009
Appendix 6 Focus Group Informed Consent	Appendix 6 Focus Group Informed Consent.doc	07/13/2009
Appendix 7 Intercept Interview Informed Consent	Appendix 7 Intercept Interview Informed Consent.doc	07/13/2009
Appendix 8 IRB Exemption Review	Appendix 8 IRB Exemption Review.doc	07/13/2009
Appendix 2 Intercept Interview Instrument Revised	Appendix 2 Intercept Interview Instrument Revised 09-0918.doc	09/30/2009
Appendix 4 Focus Group Screener Revised	Appendix 4 Focus Group Screener Revised 09-0918.doc	09/30/2009
Mini Supporting Statement 0925-0585-04 Revised	Mini Supporting Statement 0925-0585-04 Revised 09-0918.docx	09/30/2009

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