Scott County Indiana Public Service Announcements

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Document Name Document Type
Form Focus Group Protoc Scott County Indiana Public Service Announcements Form and Instruction
Focus Group Protoc Focus Group Protocol 2016_2_2_ Indiana PSA Evaluation_Attachment A.docx Form and Instruction
Screener Screener 2016_2_2_Indiana PSA Evaluation_ Attachment C.docx Form and Instruction
Facilitator Guide Facilitator Guide 2016_2_2_Indiana PSA Evaluation_Attachment D.docx Form and Instruction
2016_2_2_Indiana PSA Evaluation_Attachment B.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	Scott County Indiana Public Service Announcements	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Focus Group Protocol	Focus Group Protocol	2016_2_2_ Indiana PSA Evaluation_Attachment A.docx	Yes	Yes	Fillable Printable
Form and Instruction	Screener	Screener	2016_2_2_Indiana PSA Evaluation_ Attachment C.docx	Yes	Yes	Fillable Printable
Form and Instruction	Facilitator Guide	Facilitator Guide	2016_2_2_Indiana PSA Evaluation_Attachment D.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	2016_2_2_Indiana PSA Evaluation_Attachment B.docx	02/04/2016

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