CDC and ATSDR Health Message Testing System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0572 Attachment 3 Mod Guide_10282014	Form and Instruction	New	Available
Form 0920-0572 Attachment 4 Screener_10282014	Form and Instruction	New	Available
Parent Screener - Spanish	Form and Instruction	New	Available
Parent Screener	Form and Instruction	New	Available
Pediatrician Message Testing Moderator's Guide	Form and Instruction	New	Available
Parent Message Testing Moderator's Guide - Spanish	Form and Instruction	New	Available
Parent Message Testing Moderator's Guide	Form and Instruction	New	Available
Pediatrician Screener	Form and Instruction	New	Available
Survey for Video Testing	Form	New	Available
Eligibility Screener for Business people	Form	New	Available
Interview Guide for Videos	Form	New	Available
Dicussion Guide in English and Spanish	Form	New	Available
Screener in English and Spanish	Form	New	Available
Recruitment Script	Form	New	Available
Survey - Spanish	Form	New	Available
Form 0920-0572 ATSDR-Message-Testing_Attachment-8_Consent-Form	Form and Instruction	New	Available
Form 0920-0572 ATSDR-Message-Testing_Attachment-7_Communitymembers	Form and Instruction	New	Available
Form 0920-0572 ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals	Form and Instruction	New	Available
Form 0920-0572 ATSDR-Message-Testing_Attachment-5_Consumers	Form and Instruction	New	Available
Form 0920-0572 ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean	Form and Instruction	New	Available
Informed Consent	Form	New	Available
Screening Instrument-Radiation Emergencies Infographics	Form	New	Available
Screener	Form and Instruction	New	Available
Moderator's Guide	Form and Instruction	New	Available
Community Health Wave 4 Survey Screenshots	Form	New	Available
Community Health Wave 3 Survey Screenshots	Form	New	Available
Community Health Wave 2 Survey Screenshots	Form	New	Available
Community Health Wave 1 Survey Screenshots	Form	New	Available
Community Health Wave 4 Screener	Form	New	Available
Community Health Wave 3 Screener	Form	New	Available
Community Health Wave 2 Screener	Form	New	Available
Community Health Wave 1 Screener	Form	New	Available
African American Survey	Form	New	Available
African American Screener	Form	New	Available
Form 0920-0572 Testing of brand Appendix D2-NDPP Branding Message Testing Supplement	Form and Instruction	New	Available
Form 0920-0572 Testing of brands Appendix C2-Moderators Guide- HCP triads	Form and Instruction	New	Available
Form 0920-0572 Testing of Brand Appendix C1-Moderators Guide- Consumers FG	Form and Instruction	New	Available
Form 0920-0572 Testing of brand concepts Appendix B2-Consent form-	Form and Instruction	New	Available
Form 0920-0572 Testing of brand concepts Appendix B1-Consent form	Form and Instruction	New	Available
Form 0920-0572 Testing of brand concepts Appendix A2-Screener-HCP	Form and Instruction	New	Available
Form 0920-0572 Testing of brand Appendix A1-Screener-Consumers 010	Form and Instruction	New	Available
Form 0920-0572 Plane, Train Auto Appendix C Handheld Screenshots	Form and Instruction	New	Available
Form 0920-0572 Plane, Trains and Auto Appendix 5 Question 1 Rationale	Form and Instruction	New	Available
Form 0920-0572 Planes, Trains Auto Appendix B4 Participant Inform	Form and Instruction	New	Available
Form 0920-0572 Planes, Trains and Autop Appendix B2 Interview Cards 1	Form and Instruction	New	Available
Form 0920-0572 Plane, Trains and Auto Appendix B 1 Interview 1	Form and Instruction	New	Available
Form 0920-0572 Planes, Trains and Auto Appendix B Instructions for Interview	Form and Instruction	New	Available
Form 0920-0572 Planes, Trains and Autop Appendix B3 Response Form	Form and Instruction	New	Available
Exit Survey_English Translation	Form	New	Available
Exit Survey_Spanish	Form	New	Available
Truck Driver Opinion Survey	Form	New	Available
Screening Instrument	Form	New	Available
Form 0920-0572 Moderators Guide- General Public FG	Form and Instruction	New	Available
Form 0920-0572 Moderators Guide- Engaged Public Triad	Form and Instruction	New	Available
Form 0920-0572 Moderators Guide- Community Leaders Triad	Form and Instruction	New	Available
Moderator's Guide	Form and Instruction	New	Available
Screener	Form and Instruction	New	Available
Invitation - General Population	Form and Instruction	New	Available
Interview - General Population	Form and Instruction	New	Available
Interview - HIV+	Form and Instruction	New	Available
Screener - HIV+	Form and Instruction	New	Available
Interview - MSM	Form and Instruction	New	Available
Screener - MSM	Form and Instruction	New	Available
SS-PartB-HMTS .docx	Supporting Statement B	Uploaded 2011-11-09	Available
Att 12 - Public Comment.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 11 - IRB Ruling 060308.doc	Supplementary Document	Uploaded 2011-11-09	Available
Att 10 - Examples-Data Collection Instruments 060308.doc	Supplementary Document	Uploaded 2011-11-09	Available
Att 9-FollowUpQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 8-ActivityTaskQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 7-CoreQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 6-IntroductoryQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 5-MarketResearchExpQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 4-DemographicQuestions.docx	Supplementary Document	Uploaded 2011-11-09	Available
Att 3 - Hlth Msg Testing System Expedited Review Form.docx	Supplementary Document	Uploaded 2012-01-18	Available
Att 2_60d FRN.pdf	Supplementary Document	Uploaded 2011-11-09	Available
Att 1-AuthLegislation.pdf	Supplementary Document	Uploaded 2011-11-09	Available
SS-Part A HMTS .docx	Supporting Statement A	Uploaded 2011-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214010	Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign	Other-WORD	New
213762	Audience Research on Self-Management Education, Phase III	Form and Instruction	New	Attachment 3 Mod Guide_10282014
213762	Audience Research on Self-Management Education, Phase III	Form and Instruction	New	Attachment 4 Screener_10282014
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Parent Screener - Spanish
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Parent Screener
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Pediatrician Message Testing Moderator's Guide
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Parent Message Testing Moderator's Guide - Spanish
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Parent Message Testing Moderator's Guide
212361	Parents are the Key Teen Driving Safety Initiative	Form and Instruction	New	Pediatrician Screener
212298	Testing Business-Case Videos for CDC's Division of Community Health	Form	New	Survey for Video Testing
212298	Testing Business-Case Videos for CDC's Division of Community Health	Form	New	Eligibility Screener for Business people
212298	Testing Business-Case Videos for CDC's Division of Community Health	Form	New	Interview Guide for Videos
211907	Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	Form	New	Dicussion Guide in English and Spanish
211907	Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	Form	New	Screener in English and Spanish
211317	Spanish Trench Safety CD-ROM	Form	New	Recruitment Script
211317	Spanish Trench Safety CD-ROM	Form	New	Survey - Spanish
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	New	ATSDR-Message-Testing_Attachment-8_Consent-Form
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	New	ATSDR-Message-Testing_Attachment-7_Communitymembers
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	New	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	New	ATSDR-Message-Testing_Attachment-5_Consumers
210596	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction	New	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean
209309	Testing Health Messages in STEADI Oder Adult Fall Pevention Materials Among Caregivers	Form	New	Informed Consent
209309	Testing Health Messages in STEADI Oder Adult Fall Pevention Materials Among Caregivers	Instruction	New
208865	Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing	Other-Word	New
208746	HMTS Radiation Focus Group and Emergencies Infographics	Other-Word	New
208617	Radiation Emergencies Infographics Focus Groups	Other-Moderator's Guide-Radiation Emergencies Infographics Focus	New
208617	Radiation Emergencies Infographics Focus Groups	Form	New	Screening Instrument-Radiation Emergencies Infographics
207551	Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers	Other-WORD	New
207102	Audience Research on Self-Management Education	Form and Instruction	New	Screener
207102	Audience Research on Self-Management Education	Form and Instruction	New	Moderator's Guide
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 4 Survey Screenshots
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 3 Survey Screenshots
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 2 Survey Screenshots
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 1 Survey Screenshots
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 4 Screener
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 3 Screener
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 2 Screener
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	Community Health Wave 1 Screener
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	African American Survey
206414	African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	Form	New	African American Screener
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brand Appendix D2-NDPP Branding Message Testing Supplement
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brands Appendix C2-Moderators Guide- HCP triads
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of Brand Appendix C1-Moderators Guide- Consumers FG
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brand concepts Appendix B2-Consent form-
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brand concepts Appendix B1-Consent form
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brand concepts Appendix A2-Screener-HCP
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Testing of brand Appendix A1-Screener-Consumers 010
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Plane, Train Auto Appendix C Handheld Screenshots
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Plane, Trains and Auto Appendix 5 Question 1 Rationale
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Planes, Trains Auto Appendix B4 Participant Inform
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Planes, Trains and Autop Appendix B2 Interview Cards 1
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Plane, Trains and Auto Appendix B 1 Interview 1
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Planes, Trains and Auto Appendix B Instructions for Interview
205934	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Form and Instruction	New	Planes, Trains and Autop Appendix B3 Response Form
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Form	New	Exit Survey_English Translation
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Form	New	Exit Survey_Spanish
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Form	New	Truck Driver Opinion Survey
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Form	New	Screening Instrument
205130	Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	Instruction	New
204153	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Form and Instruction	New	Moderators Guide- General Public FG
204153	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Instruction	New
204153	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Form and Instruction	New	Moderators Guide- Engaged Public Triad
204153	Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	Form and Instruction	New	Moderators Guide- Community Leaders Triad
203482	Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Form and Instruction	New	Moderator's Guide
203482	Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Form and Instruction	New	Screener
201132	Act Against AIDS Campaign	Form and Instruction	New	Invitation - General Population
201132	Act Against AIDS Campaign	Form and Instruction	New	Interview - General Population
201132	Act Against AIDS Campaign	Form and Instruction	New	Interview - HIV+
201132	Act Against AIDS Campaign	Form and Instruction	New	Screener - HIV+
201132	Act Against AIDS Campaign	Form and Instruction	New	Interview - MSM
201132	Act Against AIDS Campaign	Form and Instruction	New	Screener - MSM

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 201111-0920-003
Status: Historical Active	Previous ICR Reference No: 201104-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/06/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/10/2011
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	02/29/2012
Responses	55,575	0	6,000
Time Burden (Hours)	7,410	0	3,000
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC must communicate about hazards, outbreaks and other emergencies that present an urgent health threat to the public. Untested messages can waste communication resources and opportunities because the messages can be perceived as unclear or irrelevant. NCHM is requesting continuing approval for an expedited review of items to be used in health messgae testing to ensure the public will understand health messages and take recommended actions.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 68358	07/26/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 189	09/29/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Act Against AIDS Campaign	none, none, none, none, none, none	Screener - MSM ,   Interview - MSM ,   Screener - HIV+ ,   Interview - HIV+ ,   Interview - General Population ,   Invitation - General Population
African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing	none, none, none, none, none, none, none, none, none, none	African American Screener ,   African American Survey ,   Community Health Wave 1 Screener ,   Community Health Wave 2 Screener ,   Community Health Wave 3 Screener ,   Community Health Wave 4 Screener ,   Community Health Wave 1 Survey Screenshots ,   Community Health Wave 2 Survey Screenshots ,   Community Health Wave 3 Survey Screenshots ,   Community Health Wave 4 Survey Screenshots
Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean ,   ATSDR-Message-Testing_Attachment-5_Consumers ,   ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals ,   ATSDR-Message-Testing_Attachment-7_Communitymembers ,   ATSDR-Message-Testing_Attachment-8_Consent-Form
Audience Research on Self-Management Education	none, none	Moderator's Guide ,   Screener
Audience Research on Self-Management Education, Phase III	0920-0572, 0920-0572	Attachment 4 Screener_10282014 ,   Attachment 3 Mod Guide_10282014
Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing
Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers
Evaluation of Emergency Preparedness Materials for Limited English Proficient Spanish-Speakers (14AHO)	none, none	Screener in English and Spanish ,   Dicussion Guide in English and Spanish
HMTS Radiation Focus Group and Emergencies Infographics
Message Testing for CDCs Division of Community Health with the General Public, Engaged Public, and Community Leaders	0920-0572, 0920-0572, 0920-0572	Moderators Guide- Engaged Public Triad ,   Moderators Guide- Community Leaders Triad ,   Moderators Guide- General Public FG
Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul	none, none, none, none	Screening Instrument ,   Truck Driver Opinion Survey ,   Exit Survey_Spanish ,   Exit Survey_English Translation
Pandemic Influenza Nonpharmaceutical Intervention Message Testing	none, none	Screener ,   Moderator's Guide
Parents are the Key Teen Driving Safety Initiative	none, none, none, none, none, none	Pediatrician Screener ,   Parent Message Testing Moderator's Guide ,   Parent Message Testing Moderator's Guide - Spanish ,   Pediatrician Message Testing Moderator's Guide ,   Parent Screener ,   Parent Screener - Spanish
Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Planes, Trains and Autop Appendix B3 Response Form ,   Planes, Trains and Auto Appendix B Instructions for Interview ,   Plane, Trains and Auto Appendix B 1 Interview 1 ,   Planes, Trains and Autop Appendix B2 Interview Cards 1 ,   Planes, Trains Auto Appendix B4 Participant Inform ,   Plane, Trains and Auto Appendix 5 Question 1 Rationale ,   Plane, Train Auto Appendix C Handheld Screenshots ,   Testing of brand Appendix A1-Screener-Consumers 010 ,   Testing of brand concepts Appendix A2-Screener-HCP ,   Testing of brand concepts Appendix B1-Consent form ,   Testing of brand concepts Appendix B2-Consent form- ,   Testing of Brand Appendix C1-Moderators Guide- Consumers FG ,   Testing of brands Appendix C2-Moderators Guide- HCP triads ,   Testing of brand Appendix D2-NDPP Branding Message Testing Supplement
Radiation Emergencies Infographics Focus Groups	None	Screening Instrument-Radiation Emergencies Infographics
Spanish Trench Safety CD-ROM	none, none	Survey - Spanish ,   Recruitment Script
Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign
Testing Business-Case Videos for CDC's Division of Community Health	none, none, none	Interview Guide for Videos ,   Eligibility Screener for Business people ,   Survey for Video Testing
Testing Health Messages in STEADI Oder Adult Fall Pevention Materials Among Caregivers	None	Informed Consent

---

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	55,575	6,000	0	49,575	0	0
Annual Time Burden (Hours)	7,410	3,000	0	4,410	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: The currently approved ICR hosts an approved question bank, managed by program. However, in a conference call on June 8, 2011, OMB staff indicated that question banks will no longer be approved. Due to this decision, Program had to revise how genICs would be submitted under this request, which Program determine would decrease the estimate burden hours required.

---

Annual Cost to Federal Government: $1,550,000

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

---

Common Form ICR:  No

---

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: 11/10/2011

---