Information Collection

Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign

IC 214010 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment-2_Screener-Tweens.docx	Other-WORD
Attachment-3_Screener-Parents.docx	Other-WORD
Attachment-4_Moderators-Guide-Tweens.docx	Other-WORD
Attachment-5_Moderators-Guide-Parents.docx	Other-WORD
Attachment-1_Background-Information.docx Att 1 Background InformaTION	IC Document
Attachment-6_Consent-Form-Parent-of-Tween.docx Att 6_ Consent Form: Parents of Tween	IC Document
Attachment-7_Assent-Form-Tweens.docx Att &_Assent Form: Tweens	IC Document
Attachment-8_Consent-Form-Parents.docx Att 8_Consent Form: Parents	IC Document
Attachment-9_Burden-Hours.docx Att 9_Burden Hours	IC Document
ATSDR-Storyboard-Testing_HMTS-Expedited-Review-Form (2).pdf HMTS Expedited Review Form	IC Document

IC Title:

Storyboard Testing Focus Groups for "No Trespassing Means No Trespassing" Campaign

Agency IC Tracking Number:

15FO

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Attachment-2_Screener-Tweens.docx	No	Paper Only
Other-WORD	Attachment-3_Screener-Parents.docx	No	Paper Only
Other-WORD	Attachment-4_Moderators-Guide-Tweens.docx	No	Paper Only
Other-WORD	Attachment-5_Moderators-Guide-Parents.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

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 Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 1 Background InformaTION	Attachment-1_Background-Information.docx	11/24/2014
Att 6_ Consent Form: Parents of Tween	Attachment-6_Consent-Form-Parent-of-Tween.docx	11/24/2014
Att &_Assent Form: Tweens	Attachment-7_Assent-Form-Tweens.docx	11/24/2014
Att 8_Consent Form: Parents	Attachment-8_Consent-Form-Parents.docx	11/24/2014
Att 9_Burden Hours	Attachment-9_Burden-Hours.docx	11/24/2014
HMTS Expedited Review Form	ATSDR-Storyboard-Testing_HMTS-Expedited-Review-Form (2).pdf	11/24/2014

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