Information Collection

Test of Effectiveness of Screening Recruitment Messages among African American Women in North Carolina

IC 200111 under ICR 200906-0920-015 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Test of Effectiveness of Screening Recruitment Messages among African American Women in North Carolina	Form
Att1a - Prediscussion Info Sheet AA Att A1a - PreDIS_AAW_10 19 2011.doc	Form
Att1b - Post-discussion Info Sheet AA Att A1b - PostDIS_AAW 10 19 2011.doc	Form
AttA2 - Prediscussion Info Sheet Latina Att A2 - PreDIS_LATINAS_10 19 2011.doc	Form
AttE1 - Recruitment Screener AA Att E1 - Recruitment Screener-AAW.doc	Form
AttE2 - Recruitment Screener Latina Att E2 - Recruitment Screener_LATINAS.doc	Form
AttJ1 - Moderator Guide AA Att J1 - Moderator Guide_AAW_10 25 2011.docx	Form and Instruction
AttJ2 - Moderator Guide Latina Att J2 - Moderator Guide_LATINAS_10 19 2011.docx	Form and Instruction
Att B - Communication Materials.pdf AttB - Communication Materials	IC Document
Att C1 - Birthday Party.wav AttC1 - Radio Health Messages	IC Document
Att C2 - MAYA NEW_1-15-09 (in mp3 format).mp3 AttC2 - Radio Health Messages	IC Document
Att C3 - Oh Harold (in mp3 format).mp3 AttC3 - Radio Health Messages	IC Document
Att D1 - Recruitment Flyer_AAW.pdf AttD1 - Recruitment Flyer AA	IC Document
Att D2 - Recruitment Flyer_LATINAS.pdf AttD2 - Recruitment Flyer Latina	IC Document
Att F - Observer Confidentiality_10 26 2011.docx AttF - Observer Nondisclosure	IC Document
Att G - Confidentiality Agreement with LSRs.doc AttG - Nondisclosure with Local Sites	IC Document
Att H1 - Informed Consent_AAW_11 03 2011.doc AttH1 - Informed Consent AA	IC Document
Att H2 - Informed Consent_LATINAS_11 03 2011.doc AttH2 - Informed Consent Latina	IC Document
Att K - Moderator PDIS.docx AttK - Moderator Version Prediscussion Sheet	IC Document
Att I - IRB approval.doc AttI - IRB Approval	IC Document
Att L - Sample Topline Summary.pdf AttL - Sample Topline Summary	IC Document
NC Project OMB Part A_11 03 2011.docx Supporting Statement A	IC Document
NC Project OMB Part B_10 19 2011.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Test of Effectiveness of Screening Recruitment Messages among African American Women in North Carolina

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	none	Att1a - Prediscussion Info Sheet AA	Att A1a - PreDIS_AAW_10 19 2011.doc	No	No	Paper Only
Form	none	Att1b - Post-discussion Info Sheet AA	Att A1b - PostDIS_AAW 10 19 2011.doc	No	No	Paper Only
Form	none	AttA2 - Prediscussion Info Sheet Latina	Att A2 - PreDIS_LATINAS_10 19 2011.doc	No	No	Paper Only
Form	none	AttE1 - Recruitment Screener AA	Att E1 - Recruitment Screener-AAW.doc	No	No	Paper Only
Form	none	AttE2 - Recruitment Screener Latina	Att E2 - Recruitment Screener_LATINAS.doc	No	No	Paper Only
Form and Instruction	none	AttJ1 - Moderator Guide AA	Att J1 - Moderator Guide_AAW_10 25 2011.docx	No	No	Paper Only
Form and Instruction	none	AttJ2 - Moderator Guide Latina	Att J2 - Moderator Guide_LATINAS_10 19 2011.docx	No	No	Paper 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: 581

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	581	0	0	0	0	0
Annual IC Time Burden (Hours)	315	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
AttB - Communication Materials	Att B - Communication Materials.pdf	11/09/2011
AttC1 - Radio Health Messages	Att C1 - Birthday Party.wav	11/09/2011
AttC2 - Radio Health Messages	Att C2 - MAYA NEW_1-15-09 (in mp3 format).mp3	11/09/2011
AttC3 - Radio Health Messages	Att C3 - Oh Harold (in mp3 format).mp3	11/09/2011
AttD1 - Recruitment Flyer AA	Att D1 - Recruitment Flyer_AAW.pdf	11/09/2011
AttD2 - Recruitment Flyer Latina	Att D2 - Recruitment Flyer_LATINAS.pdf	11/09/2011
AttF - Observer Nondisclosure	Att F - Observer Confidentiality_10 26 2011.docx	11/09/2011
AttG - Nondisclosure with Local Sites	Att G - Confidentiality Agreement with LSRs.doc	11/09/2011
AttH1 - Informed Consent AA	Att H1 - Informed Consent_AAW_11 03 2011.doc	11/09/2011
AttH2 - Informed Consent Latina	Att H2 - Informed Consent_LATINAS_11 03 2011.doc	11/09/2011
AttK - Moderator Version Prediscussion Sheet	Att K - Moderator PDIS.docx	11/09/2011
AttI - IRB Approval	Att I - IRB approval.doc	11/09/2011
AttL - Sample Topline Summary	Att L - Sample Topline Summary.pdf	11/09/2011
Supporting Statement A	NC Project OMB Part A_11 03 2011.docx	11/09/2011
Supporting Statement B	NC Project OMB Part B_10 19 2011.docx	11/09/2011

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