Information Collection

Pandemic Influenza Nonpharmaceutical Intervention Message Testing

IC 203482 under ICR 201111-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pandemic Influenza Nonpharmaceutical Intervention Message Testing	Form and Instruction
Screener Screener Protocol 071312.docx	Form and Instruction
Moderator's Guide Moderator Guide_071312.docx	Form and Instruction
Incentive Justification_071312.docx Incentive Justification	IC Document
Focus Group Materials_071312.docx Focus Group Materials	IC Document
HMTS NCEZID Expedited Review Form_071312.pdf GenIC Review Form - Project Proposal	IC Document
Privacy Act Determination_071312.docx Privacy Act Determination	IC Document

IC Title:

Pandemic Influenza Nonpharmaceutical Intervention Message 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	none	Screener	Screener Protocol 071312.docx		No	No	Paper Only
Form and Instruction	none	Moderator's Guide	Moderator Guide_071312.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

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	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	90	0	0	0	0	0
Annual IC Time Burden (Hours)	180	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
Incentive Justification	Incentive Justification_071312.docx	07/23/2012
Focus Group Materials	Focus Group Materials_071312.docx	07/23/2012
GenIC Review Form - Project Proposal	HMTS NCEZID Expedited Review Form_071312.pdf	07/23/2012
Privacy Act Determination	Privacy Act Determination_071312.docx	07/23/2012

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