Information Collection

Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing

IC 208865 under ICR 201501-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2_Eligibility Screener 08 13 13v3.docx	Other-Word
Attachment 3_Interview Protocol 08 13 13v3.docx	Other-Word
Attachment 4_Messages for Testing 08 13 13.docx	Other-Word
Attachment 1_Research Plan - Burden Table 08 13 13v3.docx Attachment 1_Research Plan - Burden Table 08 13 13v3	IC Document
HMTS Expedited Review Form 08 13 13v3.docx HMTS Expedited Review Form 08 13 13v3	IC Document
List of Attachments 08 8 13.docx List of Attachments 08 8 13	IC Document

IC Title:

Communities Putting Prevention to Work (CPPW) National Media Initiative -- Message Testing

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word	Attachment 2_Eligibility Screener 08 13 13v3.docx	Yes	Yes	Fillable Printable
Other-Word	Attachment 3_Interview Protocol 08 13 13v3.docx	Yes	Yes	Fillable Printable
Other-Word	Attachment 4_Messages for Testing 08 13 13.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1_Research Plan - Burden Table 08 13 13v3	Attachment 1_Research Plan - Burden Table 08 13 13v3.docx	09/25/2013
HMTS Expedited Review Form 08 13 13v3	HMTS Expedited Review Form 08 13 13v3.docx	09/25/2013
List of Attachments 08 8 13	List of Attachments 08 8 13.docx	09/25/2013

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