Information Collection

Back to Sleep Brand Identity Testing

IC 201164 under ICR 201110-0925-003 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Back to Sleep Brand Identity Testing	Form and Instruction
2 Moderators Guide Back To Sleep_Attachment B_Moderators Guide for State-Local-Tribal Health Professionals_0925-0643.docx	Form and Instruction
1 Screener Back To Sleep_Attachment A_Screener for State-Local-Tribal Health Professionals_0925-0643.docx	Form and Instruction
Generic_clearance_template State-Local-Tribal_NICHD Back to Sleep_0925-0643 ver 3.docx Generic_clearance_template State-Local-Tribal_NICHD Back to Sleep_0925-0643 ver 3	IC Document
Back to Sleep Logos_0925-0643.pdf Back to Sleep Logos_0925-0643	IC Document

IC Title:

Back to Sleep Brand Identity Testing

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	2	Moderators Guide	Back To Sleep_Attachment B_Moderators Guide for State-Local-Tribal Health Professionals_0925-0643.docx		Yes	Yes	Paper Only
Form and Instruction	1	Screener	Back To Sleep_Attachment A_Screener for State-Local-Tribal Health Professionals_0925-0643.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

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	23	0	0	0	0	0
Annual IC Time Burden (Hours)	52	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
Generic_clearance_template State-Local-Tribal_NICHD Back to Sleep_0925-0643 ver 3	Generic_clearance_template State-Local-Tribal_NICHD Back to Sleep_0925-0643 ver 3.docx	02/10/2012
Back to Sleep Logos_0925-0643	Back to Sleep Logos_0925-0643.pdf	02/10/2012

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