Information Collection

Qualitative Study of Perceptions and Knowledge of Visually Depicted Health Conditions

IC 218142 under ICR 201411-0910-007 · OMB 0910-0796.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0796 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Qual Study of Perceptions and Knowledge Depicted Health Conds_Addendum A - Stimuli.docx	Other-Stimuli
Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form.docx	Other-Adult Consent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form_Spanish.docx	Other-Adult Consent Form - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide.docx	Other-Interview Guide
Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide__Spanish.docx	Other-Interview Guide - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form.docx	Other-Parental Consent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form_Spanish.docx	Other-Parental Consent Form - Spanis
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Adults_Spanish.docx	Other-Screener Adults - Spanish
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Youth and Parent.doc	Other-Screener - Youth and Parent
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - YouthParent_Spanish.docx	Other-Screener Youth Parent - Spanis
Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener- Adults.doc	Other-Screener Adults
Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form.doc	Other-Youth Assent Form
Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form_Spanish.docx	Other-Youth Assent Form - Spanish
Depicted Health Conditions OMB Justification Memo.docx Supporting Statement Memo	IC Document
Depicted Health Conditions OMB Justification Memo_101415.docx Supporting Statement Memo Updated Version	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Qualitative Study of Perceptions and Knowledge of Visually Depicted Health Conditions

Agency IC Tracking Number:

CTP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Stimuli	Qual Study of Perceptions and Knowledge Depicted Health Conds_Addendum A - Stimuli.docx	No	Printable Only
Other-Adult Consent Form	Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form.docx	No	Printable Only
Other-Adult Consent Form - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Adult Consent Form_Spanish.docx	No	Printable Only
Other-Interview Guide	Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide.docx	No	Printable Only
Other-Interview Guide - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Interview Guide__Spanish.docx	No	Printable Only
Other-Parental Consent Form	Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form.docx	No	Printable Only
Other-Parental Consent Form - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Parental Consent Form_Spanish.docx	No	Printable Only
Other-Screener Adults - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Adults_Spanish.docx	No	Printable Only
Other-Screener - Youth and Parent	Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - Youth and Parent.doc	No	Printable Only
Other-Screener Youth Parent - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener - YouthParent_Spanish.docx	No	Printable Only
Other-Screener Adults	Qual Study of Perceptions and Knowledge Depicted Health Conds_Screener- Adults.doc	No	Printable Only
Other-Youth Assent Form	Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form.doc	No	Printable Only
Other-Youth Assent Form - Spanish	Qual Study of Perceptions and Knowledge Depicted Health Conds_Youth Assent Form_Spanish.docx	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,426

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,426	1,426
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Memo	Depicted Health Conditions OMB Justification Memo.docx	09/11/2015
Supporting Statement Memo Updated Version	Depicted Health Conditions OMB Justification Memo_101415.docx	10/16/2015

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