Information Collection

Message Testing for the AAA Campaign - Hispanics/Latinos

IC 208872 under ICR 201403-0920-004 · OMB 0920-0920.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0920 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0920 Message Testing for the AAA Campaign - Hispanics/Latinos	Form and Instruction
0920-0920 Message Testing for the AAA Campaign - Hispanics/Latinos Attachment 1A_Web-based Survey_Spn.docx	Form and Instruction
0920-0920 Attachment 2_Web-based Screener_Eng Attachment 2_Web-based Screener_Eng.docx	Form and Instruction
0920-0920 Attachment 1 Message Testing for the AAA Campaign - Hisp Attachment 1 Message Testing for the AAA Campaign - HispanicsLatinos.docx	Form and Instruction
0920-0920 Attachment 2A_Web-based Screener_Spn Attachment 2A_Web-based Screener_Spn.docx	Form and Instruction
Supporting Statement A.docx Supporting Statement A	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document
Attachment 3_Consent_Eng.docx Attachment 3_Consent_Eng	IC Document
Attachment 3A_Consent_Spn.docx Attachment 3A_Consent_Spn	IC Document
Attachment 4_Reminder Email_Eng.docx Attachment 4_Reminder Email_Eng	IC Document
Attachment 4A_Reminder Email_Span.docx Attachment 4A_Reminder Email_Span	IC Document
Attachment 5 Creative for Web.pdf Attachment 5 Creative for Web	IC Document
Attachment 6 CampaignMessages-WebSurvey.docx Attachment 6 CampaignMessages-WebSurvey	IC Document
CONCEPTS FOR OMB APPROVAL.pdf CONCEPTS FOR OMB APPROVAL	IC Document

IC Title:

Message Testing for the AAA Campaign - Hispanics/Latinos

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0920	Message Testing for the AAA Campaign - Hispanics/Latinos	Attachment 1A_Web-based Survey_Spn.docx	Yes	Yes	Fillable Printable
Form and Instruction	0920-0920	Attachment 2_Web-based Screener_Eng	Attachment 2_Web-based Screener_Eng.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0920	Attachment 1 Message Testing for the AAA Campaign - HispanicsLatinos	Attachment 1 Message Testing for the AAA Campaign - HispanicsLatinos.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0920	Attachment 2A_Web-based Screener_Spn	Attachment 2A_Web-based Screener_Spn.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,170

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,170	1,170
Annual IC Time Burden (Hours)	272	272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A.docx	09/26/2013
Supporting Statement B	Supporting Statement B.docx	09/26/2013
Attachment 3_Consent_Eng	Attachment 3_Consent_Eng.docx	09/26/2013
Attachment 3A_Consent_Spn	Attachment 3A_Consent_Spn.docx	09/26/2013
Attachment 4_Reminder Email_Eng	Attachment 4_Reminder Email_Eng.docx	09/26/2013
Attachment 4A_Reminder Email_Span	Attachment 4A_Reminder Email_Span.docx	09/26/2013
Attachment 5 Creative for Web	Attachment 5 Creative for Web.pdf	09/26/2013
Attachment 6 CampaignMessages-WebSurvey	Attachment 6 CampaignMessages-WebSurvey.docx	09/26/2013
CONCEPTS FOR OMB APPROVAL	CONCEPTS FOR OMB APPROVAL.pdf	09/26/2013

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