Information Collection

Bundled Sub-studies #5 (Focus Groups) and #6 (Survey) to Test Messages and Raise Public Awareness about NIH Clinical Trials

IC 195272 under ICR 201008-0925-004 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Bundled Sub-studies #5 (Focus Groups) and #6 (Survey) to Test Messages and Raise Public Awareness about NIH Clinical Trials	Form and Instruction
1 #5 Moderators Guide and Screener #5_Attach 5A Mod guide & 5B Screener_CT Campaign_2010-11-5.docx	Form and Instruction
2 #6 Web-based Survey #6_Attach 6B _CT Survey.doc	Form and Instruction
Combined GS Form_0925-0046-5 & -6.doc Combined Generic Sub-study Form #5 and #6	IC Document
Memo to OMB_Key To Bundled Pkg.doc Memo Key to Bundled Sub-studies #5 and #6	IC Document
#6_Justif Memo, Attach 6A Invite & 6C Consent_CT Survey_2010-11-9.docx #6 Justif Memo & Attach 6A Invite and 6C Consent	IC Document
#5_Justif Memo & Attach 5B Consent_CT Campaign_2010-11-9.docx #5 Justif Memo and 5C Consent	IC Document
#5_REV_Justif Memo & Attach 5C Consent_CT Campaign_2010-12-15.docx Revised #5 Just Memo	IC Document
#6_REV_Justif Memo, Attach 6A Invite & 6C Consent_CT Survey_2010-12-15.docx Revised #6 JustMemo	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Bundled Sub-studies #5 (Focus Groups) and #6 (Survey) to Test Messages and Raise Public Awareness about NIH Clinical Trials

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	#5 Moderators Guide and Screener	#5_Attach 5A Mod guide & 5B Screener_CT Campaign_2010-11-5.docx		Yes	No	Printable Only
Form and Instruction	2	#6 Web-based Survey	#6_Attach 6B _CT Survey.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-25-0156, Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 67 FR 60743

Number of Respondents: 846

Number of Respondents for Small Entity: 150

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 71 %

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	846	0	0	0	0	0
Annual IC Time Burden (Hours)	368	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
Combined Generic Sub-study Form #5 and #6	Combined GS Form_0925-0046-5 & -6.doc	11/09/2010
Memo Key to Bundled Sub-studies #5 and #6	Memo to OMB_Key To Bundled Pkg.doc	11/09/2010
#6 Justif Memo & Attach 6A Invite and 6C Consent	#6_Justif Memo, Attach 6A Invite & 6C Consent_CT Survey_2010-11-9.docx	11/09/2010
#5 Justif Memo and 5C Consent	#5_Justif Memo & Attach 5B Consent_CT Campaign_2010-11-9.docx	11/09/2010
Revised #5 Just Memo	#5_REV_Justif Memo & Attach 5C Consent_CT Campaign_2010-12-15.docx	12/22/2010
Revised #6 JustMemo	#6_REV_Justif Memo, Attach 6A Invite & 6C Consent_CT Survey_2010-12-15.docx	12/22/2010

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