Welcome to the Health and Media Survey

Community Transformation Grants: Evaluation of Nutrition, Physical Activity, and Obesity-related Television Media Campaigns

Documents and Forms

Document Name Document Type
Welcome to the Health and Media Survey Form and Instruction
Welcome to the Health and Media Survey Attachment 5a_Welcome to the Health and Media Survey.docx Form and Instruction
5b Welcome to the Health and Media Survey Attachment 5b (rev) Welcome to the Health and Media Survey Screenshot.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Welcome to the Health and Media Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Welcome to the Health and Media Survey	Attachment 5a_Welcome to the Health and Media Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	None	5b Welcome to the Health and Media Survey	Attachment 5b (rev) Welcome to the Health and Media Survey Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25,665	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25,665	25,665
Annual IC Time Burden (Hours)	1,283	1,283
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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