Data Collection Through Web Based Surveys for Evaluating Act Against AIDS Social Marketing Campaign Phases Targeting Consumers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Revised 3b Potential Exposure and Reach Sample Items.docx	Supplementary Document	Uploaded 2012-01-19	Available
Revised 3a Potential Message Effectiveness Sample Items.docx	Supplementary Document	Uploaded 2012-01-19	Repair queued
Revised Supporting Statement B 01-12-12 - Generic.docx	Supporting Statement B	Uploaded 2012-01-19	Available
Revised Attachment 6 Sample Screening Interview.docx	Supplementary Document	Uploaded 2012-01-19	Available
Attachment 5 Sample E-mail Notification.docx	Supplementary Document	Uploaded 2011-08-22	Available
Attachment 4 Sample Particpant Consent form.docx	Supplementary Document	Uploaded 2011-08-22	Repair queued
Attachment 3 Sample Survey Item Bank.docx	Supplementary Document	Uploaded 2011-08-22	Available
Revised Supporting Statement A - Generic 01-12-12.docx	Supporting Statement A	Uploaded 2012-01-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form

ICR Details

OMB Control No: 0920-0920	ICR Reference No: 201108-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Data Collection Through Web Based Surveys for Evaluating Act Against AIDS Social Marketing Campaign Phases Targeting Consumers
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 with change	Conclusion Date: 02/06/2012
	Date Received in OIRA: 08/29/2011
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved
Responses	72,000	0	0
Time Burden (Hours)	8,001	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this study is to evaluate the effectiveness of the AAA campaign messages on desired outcomes.

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Authorizing Statute(s): US Code: 42 USC 301.241 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:
	75 FR 151	08/06/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 23818	04/28/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 0

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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	72,000	0	0	72,000	0	0
Annual Time Burden (Hours)	8,001	0	0	8,001	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 new generic ICR.

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Annual Cost to Federal Government: $247,586

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 08/29/2011

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