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

CDC and ATSDR Health Message Testing System

OMB: 0920-0572

IC ID: 205130

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Attachment D - Moderator's Guide.docx Instruction
Attachment E - Participant Information Sheet.docx Instruction
Attachment C- Screen Shots.pdf Other-Screen shots
Attachment D - Sleep Debt PSA_30 seconds.mp3 Other-video
Attachment F - Whole World Changes PSA_60 seconds.mp3 Other-video
Attachment E - Whole World Changes PSA_30 seconds.mp3 Other-video
Attachment B-Recruitment Script_Spanish.docx Other-Recruitment Script_Spanish
Attachment C-Recruitment Script_English Translation.docx Other-Recruitment Script_English Tra
FinalScript_English_051812.doc Other-Test
FinalScript_Spanish_051812.doc Other-Test
GeneralTest113012v01.pdf Other-Test document
HotelTest113012v01.pdf Other-Testing document
SoftskillsTest120312v01.pdf Other-Testing document
Screening Instrument Attachment C - Screening Instrument.docx Form
Truck Driver Opinion Survey Attachment B - Truck Driver Opinion Survey.docx Form
Exit Survey_Spanish Attachment D-Exit Survey_Spanish.docx Form
Exit Survey_English Translation Attachment E-Exit Survey_English Translation.docx Form
Attachment A - Protocol Summary.docx Attachment A - Protocol Summary IC Document
Attachment B - Protocol Detail.docx Attachment B - Protocol Detail IC Document
HMTS Expedited Review Form 112812.pdf HMTS Expedited Review Form 112812 IC Document
List of Attachments.docx List of Attachments IC Document
Attachment A - Background Information.docx Attachment A - Background Information IC Document
NIOSH Hitchcock HMTS Expedited Review Form 110612.pdf NIOSH Hitchcock HMTS Expedited Review Form 110612 IC Document
List of Attachments.docx List of Attachments IC Document
HMTS Expedited Review Form 120312.pdf HMTS Expedited Review Form 120312 IC Document
List of Attachments.docx List of Attachments IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	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	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment D - Moderator's Guide.docx	Yes	Yes	Printable Only
Form	none	Screening Instrument	Attachment C - Screening Instrument.docx	Yes	Yes	Fillable Printable
Instruction			Attachment E - Participant Information Sheet.docx	Yes	Yes	Paper Only
Other-Screen shots			Attachment C- Screen Shots.pdf	Yes	Yes	Printable Only
Other-video			Attachment D - Sleep Debt PSA_30 seconds.mp3	Yes	Yes	Printable Only
Other-video			Attachment F - Whole World Changes PSA_60 seconds.mp3	Yes	Yes	Printable Only
Other-video			Attachment E - Whole World Changes PSA_30 seconds.mp3	Yes	Yes	Printable Only
Form	none	Truck Driver Opinion Survey	Attachment B - Truck Driver Opinion Survey.docx	Yes	Yes	Fillable Printable
Other-Recruitment Script_Spanish			Attachment B-Recruitment Script_Spanish.docx	Yes	Yes	Printable Only
Other-Recruitment Script_English Translation			Attachment C-Recruitment Script_English Translation.docx	Yes	Yes	Printable Only
Form	none	Exit Survey_Spanish	Attachment D-Exit Survey_Spanish.docx	Yes	Yes	Printable Only
Other-Test			FinalScript_English_051812.doc	Yes	Yes	Printable Only
Form	none	Exit Survey_English Translation	Attachment E-Exit Survey_English Translation.docx	Yes	Yes	Printable Only
Other-Test			FinalScript_Spanish_051812.doc	Yes	Yes	Printable Only
Other-Test document			GeneralTest113012v01.pdf	Yes	Yes	Printable Only
Other-Testing document			HotelTest113012v01.pdf	Yes	Yes	Printable Only
Other-Testing document			SoftskillsTest120312v01.pdf	Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 644	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	644	0	0	0	0	0
Annual IC Time Burden (Hours)	199	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A - Protocol Summary	Attachment A - Protocol Summary.docx	12/14/2012
Attachment B - Protocol Detail	Attachment B - Protocol Detail.docx	12/14/2012
HMTS Expedited Review Form 112812	HMTS Expedited Review Form 112812.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012
Attachment A - Background Information	Attachment A - Background Information.docx	12/14/2012
NIOSH Hitchcock HMTS Expedited Review Form 110612	NIOSH Hitchcock HMTS Expedited Review Form 110612.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012
HMTS Expedited Review Form 120312	HMTS Expedited Review Form 120312.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012

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