OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Screening/Participation Instruments

IC 197102 under ICR 201105-1505-001 · OMB 1505-0233.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
SPANISHmoderatorguidemay19.docx Other-Moderator Guide (Spanish)
Spanishrecruitingscript_May13.docx Other-Recruitment Script (Spanish)
spanishtranslationfollowuprecruitingmaterials.docx Other-Recruiting Followup (Spanish)
PRA tool acknowledgement letter to participants 051911 - Final.doc Other-Acknowledgement Letter
PRa tool consent forms 051911 - Final.docx Other-Consent Form
PRA tool consumer recruitment phone script 051911 - Final.doc Other-Recruitment Script Consumer
PRA tool industry recruitment phone script 051911 - Final.doc Other-Recruitment Script Industry
PRA tool moderators guide consumer 051911 - Final.doc Other-Moderator's Guide Consumer
PRA tool moderators guide industry 051911 - Final.doc Other-Moderator's Guide Industry
PRA tool participant questionnaire 051911 - Final.doc Other-Participant Questionnaire
PRA tool participant reminder telephone script 051911 - Final.doc Other-Participant Reminder
PRA Tool Scenario Cards 051911 - Final.doc Other-Scenario Cards
Option1_ANL.PDF Other-Sample (Ficus & Beech)
Option1_B.pdf Other-Sample (Fir & Balsam)
Option2_ANL.PDF Other-Sample (Pecan & Laurel)
Option2_B.PDF Other-Sample (Poplar & Lilac)
Opt1_A_ESP_BALSAM_v2.pdf Other-Sample
Opt1_A_ESP_BEECH_v2.pdf Other-Sample
Opt1_A_ESP_FICUS_v2.pdf Other-Sample
Opt1_A_ESP_FIR_v2.pdf Other-Sample
Opt2_A_ESP_LAUREL_v2.pdf Other-Sample
Opt2_A_ESP_LILAC_v2.pdf Other-Sample
Opt2_A_ESP_PECAN_v2.pdf Other-Sample
Opt2_A_ESP_POPLAR_v2.pdf Other-Sample
Description of Study-Overview.doc
Description of Study/Overview		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other-Moderator Guide (Spanish) No   Paper Only
Other-Recruitment Script (Spanish) No   Paper Only
Other-Recruiting Followup (Spanish) No   Paper Only
Other-Acknowledgement Letter No   Paper Only
Other-Consent Form No   Paper Only
Other-Recruitment Script Consumer No   Paper Only
Other-Recruitment Script Industry No   Paper Only
Other-Moderator's Guide Consumer No   Paper Only
Other-Moderator's Guide Industry No   Paper Only
Other-Participant Questionnaire No   Paper Only
Other-Participant Reminder No   Paper Only
Other-Scenario Cards No   Paper Only
Other-Sample (Ficus & Beech) Yes No Printable Only
Other-Sample (Fir & Balsam) Yes No Printable Only
Other-Sample (Pecan & Laurel) Yes No Printable Only
Other-Sample (Poplar & Lilac) Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only
Other-Sample Yes No Printable Only

Federal Enterprise Architecture Business Reference Module


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 230 0 0 0 0 230
Annual IC Time Burden (Hours) 315 0 0 0 0 315
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Description of Study/Overview 04/05/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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