Information Collection

Risk of Alcohol Use During Pregnancy: Message Testing and Materials Development

IC 201748 under ICR 201112-0920-014 · OMB 0920-0919.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0919 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Risk of Alcohol Use During Pregnancy: Message Testing and Materials Development	Form and Instruction
Attch 2_Focus Group Guide_Alcohol and Pregnancy Message Testing_01-23-12 (2).docx	Other-Focus Group Guide
1 Recruitment Screener for Focus Groups Attch 1_Focus Group Participant Screener_Alcohol and Pregnancy Message Testing_01-23-12.docx	Form and Instruction
Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12.docx Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12	IC Document
Supplemental 2_FASD Adcepts_Final for Testing.pdf Supplemental 2_FASD Adcepts_Final for Testing	IC Document
Supp 3_Brochure_Alcohol and Pregnancy and FASDs_Final for Testing.pdf Supp 3_Brochure_Alcohol and Pregnancy and FASDs_Final for Testing	IC Document
GenIC Clearance Submission_Alcohol and Pregnancy Message Testing_01-26-12 (2).docx GenIC Clearance Submission_Alcohol and Pregnancy Message Testing_01-26-12 (2)	IC Document

IC Title:

Risk of Alcohol Use During Pregnancy: Message Testing and Materials Development

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	1	Recruitment Screener for Focus Groups	Attch 1_Focus Group Participant Screener_Alcohol and Pregnancy Message Testing_01-23-12.docx		No	No	Paper Only
Other-Focus Group Guide			Attch 2_Focus Group Guide_Alcohol and Pregnancy Message Testing_01-23-12 (2).docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

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	480	0	0	0	0	0
Annual IC Time Burden (Hours)	207	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
Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12	Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12.docx	03/28/2012
Supplemental 2_FASD Adcepts_Final for Testing	Supplemental 2_FASD Adcepts_Final for Testing.pdf	03/28/2012
Supp 3_Brochure_Alcohol and Pregnancy and FASDs_Final for Testing	Supp 3_Brochure_Alcohol and Pregnancy and FASDs_Final for Testing.pdf	03/28/2012
GenIC Clearance Submission_Alcohol and Pregnancy Message Testing_01-26-12 (2)	GenIC Clearance Submission_Alcohol and Pregnancy Message Testing_01-26-12 (2).docx	03/28/2012

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