HMT Request Template

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)

Spanish Trench Safety CD-ROM

2. Study Population: (Discuss study population and explain how they will be selected/recruited.)

Adult Latino immigrants who work in and around trenches. Individuals will be recruited through local
construction companies and community organizations.

Respondent characteristics:
Number of subject: 100

Number of males:

100

Age range: 18 and older

Number of females: 0

Racial/ethnic composition: Latino
Special group status: (e.g., risk group, health care providers)
Type of group(s): Immigrants
Geographic location(s): Baltimore

3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

Participants will receive $25 for their participation in the study. The total time burden for each respondent
is 1 hour. The average construction worker in the Washington DC area makes $23.00 an hour. The
incentive schedule is consistent with the average salary for construction workers in Maryland which is $25
an hour. See Attachment G for a justification for the incentive amount.

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Other (describe):

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no):

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)

The goal of this study is to determine the most effective way to disseminate trench safety information to
Latino immigrant workers using computer based training. Specifically the study will evaluate an
interactive and non-interactive Spanish language trench safety CD-ROM to determine the most effective
format for use with Latino immigrant workers. Attachment B: Survey Items – Spanish collects data on the
information materials regarding message, distribution channel preferences and participant recall.
6. Category of time sensitivity: (Please check one below)
Health emergency:
Time-limited audience access:
Press coverage correction:
Time-limited congressional/administrative mandate:
Trend Tracking
Ineffective existing materials due to historical event/social trends:
7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
It is anticipated that data collection, including recruitment, will take 2 months to complete. The contract
for the data collection expires in September of 2014.

8. Number of burden hours requested: 100

BURDEN HOURS
No. of
Participation
Respondents Time

Category of Respondent
Construction Workers in Baltimore

100

1 hour

Burden
100 hours

Totals
9. Are you using questions from the approved question bank?

Yes

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)
The following items come from HMTS Question Bank (OMB No. 0920-5072) dated February 2011:
1a, 2a, 11a, 13a
*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation: 3109
2. OADC confirmation of time-sensitivity:
Yes:
No:

Barbara Morrison
Project Officer
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