Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC)

Formative Research and Tool Development

OMB: 0920-0840

IC ID: 213098

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Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC) 0920-0840-14AXK
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form None Review Material Patient Adherence Brochure Att 5.5_Patient Adherence Brochure.pdf None No   Paper Only
Form None Review Material Adherence Wall Poster Att 5.6_Adherence Wall Poster.pdf None No   Paper Only
Form None Review Material Risk Reduction MD Brochure Att 5.7_Risk Reduct MD Brochure.pdf None No   Paper Only
Form None Review Material Patient Action Plan Att 5.8_Patient Action Plan.pdf None No   Paper Only
Form None Review Material Patient Risk Reduction Brochure Att 5.9_Patient Risk Reduct Brochure.pdf No   Paper Only
Form None Review Material Retention Brochure MD Att 5.10_Retent MD Brochure.pdf None No   Paper Only
Form None Review Material Patient Record Form Att 5.11_Patient Record Form.pdf None No   Paper Only
Form None Review Material Retention Brochure Patient Att 5.12_Patient Retent Brochure.pdf None No   Paper Only
Form None Review Material Retention Poster Att 5.13_Retent_Poster.pdf None No   Paper Only
Form None Review Material Gardner Study Reprint Att 5.14_Gardner Reprint Carrier.pdf None No   Paper Only
Form None Review Material Adherence Brochure MD Att 5.15_Adherence MD Brochure.pdf None No   Paper Only
Form None CME Promotion Card Att 5.16_CME Promo Card.pdf None No   Paper Only
Form None Review Material Risk Reduction Poster Option Att 5.17_Risk Reduct Poster Option.pdf None No   Paper Only
Form and Instruction None Provider Screening Instrument Att 4 Provider Screening Instrument.docx None No   Paper Only
Form None Paper and Pencil Survey Att 2 Paper and Pencil Survey.docx None No   Paper Only
Form None Informed Consent Form Att 6 Informed Consent Forms.docx None No   Paper Only
Form and Instruction None Provider Screening Instrument Att 3 Provider Interview Guide.docx None No   Paper Only
Form None Review Material-Envelope Att 5.1_Envelope.pdf None No   Paper Only
Form None Review Material Folder Att 5.2_Folder.pdf None No   Paper Only
Form None Review Material Brouchure and Folding Instructions Att 5.3_BRC & folding instructions.pdf None No   Paper Only
Form None Review Material Patient Baseline Screen Att 5.4_Patient Baseline Screener.pdf None No   Paper Only

Health Public Health Monitoring

 

480 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 480 0 480 0 0 0
Annual IC Time Burden (Hours) 154 0 154 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
IRB Approval Letter Att 7 IRB Approval.pdf 09/24/2014
Reminder Email Letter Att 8 Reminder Email_Letter.docx 09/24/2014
Supporting Statement B SSB 02SEP2014.docx 09/24/2014
Privacy Agreement Att 1 Privacy Agreement.docx 09/24/2014
Supporting Statement A SSA 07OCT14.doc 10/07/2014
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