Information Collection

Questionnaire Bank

IC 187037 under ICR 200904-0920-011 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
REVISED Health Message Testing System - Attachment 4 - Demographic Questions.doc	Other-Interview
Health Message Testing System - Attachment 5 - Market Research Experience Questions.doc	Other-Interview
Health Message Testing System - Attachment 6 - Introductory Questions.doc	Other-Interview
Health Message Testing System - Attachment 7 - Core Questions.doc	Other-Interview
Health Message Testing System - Attachment 8 - Activity-Task Questions.doc	Other-Interview
Health Message Testing System - Attachment 9 - Follow-Up Questions.doc	Other-Interview

IC Title:

Questionnaire Bank

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview	REVISED Health Message Testing System - Attachment 4 - Demographic Questions.doc	Yes	No	Paper Only
Other-Interview	Health Message Testing System - Attachment 5 - Market Research Experience Questions.doc	Yes	No	Paper Only
Other-Interview	Health Message Testing System - Attachment 6 - Introductory Questions.doc	Yes	No	Paper Only
Other-Interview	Health Message Testing System - Attachment 7 - Core Questions.doc	Yes	No	Paper Only
Other-Interview	Health Message Testing System - Attachment 8 - Activity-Task Questions.doc	Yes	No	Paper Only
Other-Interview	Health Message Testing System - Attachment 9 - Follow-Up Questions.doc	Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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