OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing

IC 206414 under ICR 201501-0920-003 · OMB 0920-0572.

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

African American STD Disparities Health Communications Project and Community Health Media Center Educational Campaign Materials Testing
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none African American Screener African Amer - Attachment 3 - Survey screener 040313.doc Yes Yes Fillable Fileable
Form none African American Survey African Amer - Attachment 4 - Survey 022513.doc Yes Yes Fillable Fileable
Form none Community Health Wave 1 Screener Attachment 2a - Wave 1 Beverages - Screener - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 2 Screener Attachment 3a - Wave 2 Physical Activity - Screener - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 3 Screener Attachment 4a - Wave 3 Food - Screener - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 4 Screener Attachment 5a - Wave 4 Healthy Living - Screener - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 1 Survey Screenshots Attachment 2c - Wave 1 Beverages - Screenshots - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 2 Survey Screenshots Attachment 3c - Wave 2 Physical Activity - Screenshots - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 3 Survey Screenshots Attachment 4c - Wave 3 Food - Screenshots - 040413.pdf Yes Yes Fillable Fileable
Form none Community Health Wave 4 Survey Screenshots Attachment 5c - Wave 4 Healthy Living - Screenshots - 040413.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

5,950 0
   
Individuals or Households
 
   100 %

  Requested 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 5,950 0 0 0 0 5,950
Annual IC Time Burden (Hours) 2,406 0 0 0 0 2,406
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
African American HTMS Expedited Review Form African Amer HMTS Expedited Review Form 022513.pdf 04/03/2013
African American Email Invitation and Reminders African Amer - Attachment 2 - Survey Invitation and Reminder E-Mails 022513.docx 04/03/2013
African American IRB Letter Attachment 11 - IRB Ruling 060308.doc 04/03/2013
African American Consent African Amer -Attachment 1- Consent Form 022513.doc 04/04/2013
Community Health HMTS Expedited Review Form Community Health - HMTS Expedited Review Form - 040213.pdf 04/04/2013
Community Health Summary of Procedures Community Health Attachment 1 - TOC - Summary of Procedures - Burden Table - 040213.pdf 04/04/2013
Community Health Wave 1 Materials Attachment 2d - Wave 1 Beverages - Materials List - 040413.pdf 04/08/2013
Community Health Wave 2 Materials Attachment 3d - Wave 2 Physical Activity - Materials List - 040413.pdf 04/08/2013
Community Health Wave 3 Materials Attachment 4d - Wave 3 Food - Materials List - 040413.pdf 04/08/2013
Community Health Wave 4 Materials Attachment 5d - Wave 4 Healthy Living - Materials List - 040413.pdf 04/08/2013
Community Health Wave 1 Survey Attachment 2b - Wave 1 Beverages - Survey - 040413.pdf 04/08/2013
Community Health Wave 2 Survey Attachment 3b - Wave 2 Physical Activity - Survey - 040413.pdf 04/08/2013
Community Health Wave 3 Survey Attachment 4b - Wave 3 Food - Survey - 040413.pdf 04/08/2013
Community Health Wave 4 Survey Attachment 5b - Wave 4 Healthy Living - Survey - 040413.pdf 04/08/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.