OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Media Tracking Questionnaires 1st, 2nd and; 3rd

IC 208714 under ICR 201407-0910-001 · OMB 0910-0753.

Documents and Forms
Document Name
Document Type
Instruction
Other-Survey
Instruction
Instruction
Instruction
Instruction
Other-Survey
Instruction
Instruction
Instruction
Instruction
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Media Tracking Questionnaires 1st, 2nd and; 3rd
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment_4a_Rationale_for_conducting_Media_Tracking Clean.docx Yes No Printable Only
Other-Survey Attachment_4_Media_Tracking_Screener_and_Instrument clean.doc Yes No Fillable Printable
Instruction Attachment 7_Introduction to Study_tracked changes.doc Yes No Printable Only
Instruction Attachment 8_Study Description_tracked changes.doc Yes No Printable Only
Instruction Attachment 9_Privacy and Data Security.doc Yes No Printable Only
Instruction Attachment 11_Questions and Answers about the ExPECTT Evaluation_tracked changes.doc Yes No Printable Only
Other-Survey Attachment 12_Telephone Verification Survey_tracked changes.doc Yes No Printable Only
Instruction Attachment 13_Notifications_tracked changes.doc Yes No Printable Only
Instruction Attachment 5_Incentives-070214.doc Yes No Printable Only
Instruction Attachment 6_Parent Permission-070214.doc Yes No Printable Only
Instruction Attachment 6_Youth Consent-070214.doc Yes No Printable Only
Instruction Attachment 10_ Lead Letter-070214.doc Yes No Printable Only

Health Immunization Management

 

3,999 0
   
Individuals or Households
 
   100 %

  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 3,999 0 0 0 0 3,999
Annual IC Time Burden (Hours) 2,001 0 0 0 0 2,001
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.