Information Collection

Focus Groups and Intercept Interviews for Message and Materials Pretesting

IC 189989 under ICR 201005-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Focus Groups and Intercept Interviews for Message and Materials Pretesting	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	377	377
Annual IC Time Burden (Hours)	220	220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.