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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

IC 205934 under ICR 201111-0920-003 · OMB 0920-0572.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-0572
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
0920-0572 Planes, Trains and Autop Appendix B3 Response Form
Appendix B3 Response Form.docx 		Form and Instruction
0920-0572 Planes, Trains and Auto Appendix B Instructions for Inte
Appendix B Instructions for Interviewers 1.docx 		Form and Instruction
0920-0572 Plane, Trains and Auto Appendix B 1 Interview 1
Appendix B1 Interview 1.docx 		Form and Instruction
0920-0572 Planes, Trains and Autop Appendix B2 Interview Cards 1
Appendix B2 Interview 1 Cards.pptx 		Form and Instruction
0920-0572 Planes, Trains Auto Appendix B4 Participant Inform
Appendix B4 Participant Information Sheet.docx 		Form and Instruction
0920-0572 Plane, Trains and Auto Appendix 5 Question 1 Rationale
Appendix B5 Question 1 Rationale_v2.docx 		Form and Instruction
0920-0572 Plane, Train Auto Appendix C Handheld Screenshots
Appendix C Handheld Screenshots.docx 		Form and Instruction
0920-0572 Testing of brand Appendix A1-Screener-Consumers 010
Appendix A1-Screener-Consumers 010713.docx 		Form and Instruction
0920-0572 Testing of brand concepts Appendix A2-Screener-HCP
Appendix A2-Screener-HCP 010713.docx 		Form and Instruction
0920-0572 Testing of brand concepts Appendix B1-Consent form
Appendix B1-Consent form-Consumer FGs 122812.docx 		Form and Instruction
0920-0572 Testing of brand concepts Appendix B2-Consent form-
Appendix B2-Consent form-HCP Triads 122812.docx 		Form and Instruction
0920-0572 Testing of Brand Appendix C1-Moderators Guide- Consumers
Appendix C1-Moderators Guide- Consumers FG 020613.docx 		Form and Instruction
0920-0572 Testing of brands Appendix C2-Moderators Guide- HCP tria
Appendix C2-Moderators Guide- HCP triads 020613.docx 		Form and Instruction
0920-0572 Testing of brand Appendix D2-NDPP Branding Message Testi
Appendix D2-NDPP Branding Message Testing Supplement 010713.docx 		Form and Instruction
HMTSExpeditedReviewForm Interview 1.pdf
Planes, Trains, Auto HMTSExpeditedReviewForm Interview 1		IC Document
HMTSExpeditedReviewForm- NPPP branding and message testing 011113.pdf
NPPP Brand and Message Testing Expedited Review Form		IC Document
List of Appendices.docx
Testing of brands list of Appendices		IC Document
Appendix A.docx
Planes, Trains and auto Appendix A		IC Document
Appendix A1 IRB Approval.docx
Planes, Trains Auto Appendix A1 IRB Approval		IC Document

Information Collection (IC) Details

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layout table

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 0920-0572 Planes, Trains and Autop Appendix B3 Response Form Appendix B3 Response Form.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Planes, Trains and Auto Appendix B Instructions for Interview Appendix B Instructions for Interviewers 1.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Plane, Trains and Auto Appendix B 1 Interview 1 Appendix B1 Interview 1.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Planes, Trains and Autop Appendix B2 Interview Cards 1 Appendix B2 Interview 1 Cards.pptx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Planes, Trains Auto Appendix B4 Participant Inform Appendix B4 Participant Information Sheet.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Plane, Trains and Auto Appendix 5 Question 1 Rationale Appendix B5 Question 1 Rationale_v2.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Plane, Train Auto Appendix C Handheld Screenshots Appendix C Handheld Screenshots.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brand Appendix A1-Screener-Consumers 010 Appendix A1-Screener-Consumers 010713.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brand concepts Appendix A2-Screener-HCP Appendix A2-Screener-HCP 010713.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brand concepts Appendix B1-Consent form Appendix B1-Consent form-Consumer FGs 122812.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brand concepts Appendix B2-Consent form- Appendix B2-Consent form-HCP Triads 122812.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of Brand Appendix C1-Moderators Guide- Consumers FG Appendix C1-Moderators Guide- Consumers FG 020613.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brands Appendix C2-Moderators Guide- HCP triads Appendix C2-Moderators Guide- HCP triads 020613.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Testing of brand Appendix D2-NDPP Branding Message Testing Supplement Appendix D2-NDPP Branding Message Testing Supplement 010713.docx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


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 344 0 0 0 0 0
Annual IC Time Burden (Hours) 261 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
Planes, Trains, Auto HMTSExpeditedReviewForm Interview 1 HMTSExpeditedReviewForm Interview 1.pdf 02/19/2013
NPPP Brand and Message Testing Expedited Review Form HMTSExpeditedReviewForm- NPPP branding and message testing 011113.pdf 02/21/2013
Testing of brands list of Appendices List of Appendices.docx 02/21/2013
Planes, Trains and auto Appendix A Appendix A.docx 02/21/2013
Planes, Trains Auto Appendix A1 IRB Approval Appendix A1 IRB Approval.docx 02/21/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.