Information Collection

Screening/Participation Instruments

IC 197102 under ICR 201109-1505-001 · OMB 1505-0233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0233 can be found here:

2011-10-17 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document 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
Revised_recruiting_script_060911.docx	Other-Recruiting Script
moderators guide consumer 0620 compare with 0511.doc	Other-Moderator's Guide
Revised Confidentiality Statement and Consent Form 060611 clean.docx	Other-Consent
Revised_part__questionnaire_060911 clean.docx	Other-Questionnaire
Round 2 Moderators Guide_Consumer_062011 v2.docx	Other-Moderator's Guide
Round 2_Moderator Guide_Industry_0621 clean.docx	Other-Moderator's Guide
Round 3 Moderators Guide_Consumer_072711_OMBOGC.docx	Other-Moderator's Guide
Round 4 Moderators Guide_Consumer 083111 clean.docx	Other-Moderator's Guide
Description of Study-Overview.doc Description of Study/Overview	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Screening/Participation Instruments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Moderator Guide (Spanish)	SPANISHmoderatorguidemay19.docx	No		Paper Only
Other-Recruitment Script (Spanish)	Spanishrecruitingscript_May13.docx	No		Paper Only
Other-Recruiting Followup (Spanish)	spanishtranslationfollowuprecruitingmaterials.docx	No		Paper Only
Other-Acknowledgement Letter	PRA tool acknowledgement letter to participants 051911 - Final.doc	No		Paper Only
Other-Consent Form	PRa tool consent forms 051911 - Final.docx	No		Paper Only
Other-Recruitment Script Consumer	PRA tool consumer recruitment phone script 051911 - Final.doc	No		Paper Only
Other-Recruitment Script Industry	PRA tool industry recruitment phone script 051911 - Final.doc	No		Paper Only
Other-Moderator's Guide Consumer	PRA tool moderators guide consumer 051911 - Final.doc	No		Paper Only
Other-Moderator's Guide Industry	PRA tool moderators guide industry 051911 - Final.doc	No		Paper Only
Other-Participant Questionnaire	PRA tool participant questionnaire 051911 - Final.doc	No		Paper Only
Other-Participant Reminder	PRA tool participant reminder telephone script 051911 - Final.doc	No		Paper Only
Other-Sample	Opt1_A_ESP_FICUS_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt1_A_ESP_FIR_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt2_A_ESP_LAUREL_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt2_A_ESP_LILAC_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt2_A_ESP_PECAN_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt2_A_ESP_POPLAR_v2.pdf	Yes	No	Printable Only
Other-Recruiting Script	Revised_recruiting_script_060911.docx	Yes	No	Printable Only
Other-Scenario Cards	PRA Tool Scenario Cards 051911 - Final.doc	No		Paper Only
Other-Moderator's Guide	moderators guide consumer 0620 compare with 0511.doc	No		Printable Only
Other-Consent	Revised Confidentiality Statement and Consent Form 060611 clean.docx	Yes	No	Printable Only
Other-Questionnaire	Revised_part__questionnaire_060911 clean.docx	Yes	Yes	Fillable Fileable
Other-Moderator's Guide	Round 2 Moderators Guide_Consumer_062011 v2.docx	No		Printable Only
Other-Moderator's Guide	Round 2_Moderator Guide_Industry_0621 clean.docx	No		Printable Only
Other-Moderator's Guide	Round 3 Moderators Guide_Consumer_072711_OMBOGC.docx	No		Printable Only
Other-Moderator's Guide	Round 4 Moderators Guide_Consumer 083111 clean.docx	No		Printable Only
Other-Sample (Poplar & Lilac)	Option2_B.PDF	Yes	No	Printable Only
Other-Sample	Opt1_A_ESP_BALSAM_v2.pdf	Yes	No	Printable Only
Other-Sample	Opt1_A_ESP_BEECH_v2.pdf	Yes	No	Printable Only
Other-Sample (Ficus & Beech)	Option1_ANL.PDF	Yes	No	Printable Only
Other-Sample (Fir & Balsam)	Option1_B.pdf	Yes	No	Printable Only
Other-Sample (Pecan & Laurel)	Option2_ANL.PDF	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 230

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	230	230
Annual IC Time Burden (Hours)	315	315
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Description of Study/Overview	Description of Study-Overview.doc	04/05/2011

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