Customer Feedback Information for National Institute on Drug Abuse PEERx Videos

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

OMB: 0925-0655

IC ID: 212391

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Customer Feedback Information for National Institute on Drug Abuse PEERx Videos
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Screenshot Student Survey Attachment 10- Screenshot Student Questionnaire.pdf Yes Yes Fillable Fileable
Form and Instruction 2 Screenshot Teacher Survey Attachment 11- Screenshot-Teacher Questionnaire.pdf Yes Yes Fillable Fileable
Form 3 Messaging Moderator’s Guide Attachment 12 -_Messaging _Moderators Guide Prescription.doc No   Paper Only
Form 4 FG Moderator’s Guide Attachment 13 -FG_ModeratorsGuide PEERx Video Testing.doc No   Paper Only
Form 5 Student Focus Group Recruitment Screener Attachment 14- Student Focus Group Recruitment Screener.docx No   Paper Only

Health Health Care Services

 

798 0
   
Individuals or Households
 
   50 %

  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 798 0 798 0 0 0
Annual IC Time Burden (Hours) 391 0 391 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Sampling Plan Attachment 1 - Sampling Plan -04032014.doc 07/24/2014
Letter to Principals Explaining Study Attachment 2 - Letter to Principals Explaining Study 04032014.pdf 07/24/2014
Principal’s Consent Form Attachment 3 - Principal's Consent Form.doc 07/27/2014
Request to Principals to Host Focus Group Attachment 4 -Request to Principals to Host a Focus Group.docx 07/27/2014
Consent Assent Focus Group Participation Attachment 5 - Consent Assent Focus Group Participation -.docx 07/27/2014
Consent Assent Survey Attachment 6 - Consent Assent Survey.docx 07/27/2014
Teacher Consent Attachment 7 -Teacher Consent -.docx 07/27/2014
IRB Approval Letter IRB Approval Letter - Customer Satisfaction NIDA PEERx Videos 04032014.pdf 07/27/2014
Student Survey Attachment 8 - Student Survey.doc 07/27/2014
Teacher Survey Attachment 9- Teacher Survey.doc 07/27/2014
Fast Track Template NIDA Fast Track Template 04032104 - Customer Feedback Information on NIDAs Choose Your Path Videos-20140313J (2).doc 07/27/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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