Evaluation of Health Communication Messages for Infertility Prevention Campaign

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
VS_092008AA_Section B-6 12 09.doc	Supporting Statement B	Uploaded 2009-07-20	Available
VS_IRB Auth Agreement-Attachment5.pdf	Supplementary Document	Uploaded 2009-07-20	Available
VS_0920-08AA_Attachment 4C_Adult Informed Verbal Consent.doc	Supplementary Document	Uploaded 2009-07-20	Available
VS_0920-08AA_Attachment 4B_Parent-Guardian Informed Verbal Consent[15-17]FGdoc.doc	Supplementary Document	Uploaded 2009-07-20	Available
VS_0920-08AA_Attachment4A_Minor Informed Verbal Assent.doc	Supplementary Document	Uploaded 2009-07-20	Available
VS_0920-08AA_Attachment1_AuthLeg.doc.pdf	Supplementary Document	Uploaded 2009-07-20	Available
VS_0920-08AA_Attachment 2B_60Day.doc	Supplementary Document	Uploaded 2009-07-20	Available
V-PS0920-08AA_attachment2A.doc	Supplementary Document	Uploaded 2009-07-20	Available
VS_092008AA_Section A-6 12 09.doc	Supporting Statement A	Uploaded 2009-07-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190374	Online Screener and Survey	Other-Screener / Survey	New
190373	Mall Intercept Screener & Moderator Guide - All	Other-Screener and Moderator Guide	New
190372	Focus Group Moderator Guide - All	Other-Moderator Guide	New
190371	Focus Group Screener for Adult Women	Other-Screener	New
190370	Focus Group Screener for Minors	Other-Screener	New
190369	Focus Group Screener for Parents of Minors	Other-Screener	New

ICR Details

OMB Control No: 0920-0825	ICR Reference No: 200908-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of Health Communication Messages for Infertility Prevention Campaign
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 without change	Conclusion Date: 10/13/2009
	Date Received in OIRA: 08/19/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved
Responses	1,114	0	0
Time Burden (Hours)	481	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This study will test health communication messages, concepts and products designed to raise awareness and increase Chlamydia trachomatis screening for girls and women age 15-25. Both exploratory and formative research will be used to test health communication messages and products about sexual/reproductive health and Chlamydia trachomatis.

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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:
	74 FR 6160	02/05/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 36491	07/23/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Focus Group Screener for Adult Women
Focus Group Moderator Guide - All
Mall Intercept Screener & Moderator Guide - All
Online Screener and Survey
Focus Group Screener for Minors
Focus Group Screener for Parents of Minors

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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	1,114	0	0	1,114	0	0
Annual Time Burden (Hours)	481	0	0	481	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 data collection.

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Annual Cost to Federal Government: $349,462

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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)? No

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: 08/19/2009

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