Raising Public Awareness for Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB: 0920-0919

IC ID: 202588

Documents and Forms
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Information Collection (IC) Details

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Raising Public Awareness for Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener Atlanta Male 40-64 Att 2_Screener_2_Atlanta_Hospitalized-male_40-64_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Atlanta Female 18-39 Att 1_Screener_1_Atlanta_Hospitalized-female_18-39_corrected4_12_12.doc Yes No Fillable Fileable
Form none Screener Atlanta Male 65-80 Att 3_Screener_3_Atlanta_Hospitalized-male_65-80-seniors_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Atlanta Female 40-64 Att 4_Screener_4_Atlanta_Hospitalized-female_40-64_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Baltimore Female 18-39 Att 5_Screener_5_Baltimore_Hospitalized-female_18-39_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Baltimore Male 18-39 Att 6_Screener_6_Baltimore_Hospitalized-male-18-39_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Baltimore Female 65-80 Att 7_Screener_7_Baltimore_Hospitalized-female_65-80-seniors_corrected 4_12_12.doc Yes No Fillable Fileable
Form none Screener Baltimore Male 40-64 Att 8_Screener_8_Baltimore_Hospitalized-male_40-64_corrected4_12_12.doc Yes No Fillable Fileable
Form none Rescreener Att 9_Rescreener_Hospitalized_3 26 12Final.docx Yes No Fillable Fileable
Form none Informed Consent Atlanta Att 10_Informed Consent_Atlanta (rev).docx Yes No Fillable Printable
Form none Informed Consent Baltimore Att 12_Informed Consent_Baltimore (rev).docx No No Printable Only
Form none Focus Group Discussion Guide Att 13_DVT MT Discussion Guide.docx Yes No Printable Only
Form none Informed Consent Atlanta-evening Att 11_Informed Consent_Atlanta-evening (rev).docx Yes No Printable Only

Health Immunization Management

 

360 0
   
Individuals or Households
 
   0 %

  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 360 0 0 0 0 0
Annual IC Time Burden (Hours) 148 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval DVT GenIC Clearance Submission _ option year_3 29_12_amended1.docx 06/04/2012
DVT Presentation Slides CDC DVT PPT REV 032612_slideshow.ppt 06/04/2012
DVT Message Concepts DVT message concepts 3-26-12_FINAL.docx 06/04/2012
DVT Awareness Ads DVT-PE Awareness Ads Finalists REV_030912.pdf 06/04/2012
Justification for Incentives dvt incentive justificationCS-JB.docx 06/04/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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