Information Collection

Testing Business-Case Videos for CDC's Division of Community Health

IC 212298 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⚠️ Notice: This information collection may be referencing outdated material.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
Testing Business-Case Videos for CDC's Division of Community Health	Form
Interview Guide for Videos Attachment 3_Interview guide for video testing with businesspeople (05-15-14) DCH Video Testing.docx	Form
Eligibility Screener for Business people Attachment 4_Eligibility screener for businesspeople (05-15-14) DCH Video Testing.docx	Form
Survey for Video Testing Attachment 5_Survey for video testing with awardees (05-15-14) DCH Video Testing.docx	Form
HMTS Expedited Review Form (07-01-14) DCH Video Testing.docx Request for Expedited Review	IC Document
Attachment 1_Research plan and burden table (5-15-14) DCH Video Testing .docx Research Plan	IC Document
Attachment 2_Videos for testing (05-15-14) DCH Video Testing.docx Videos for Testing/Links	IC Document

IC Title:

Testing Business-Case Videos for CDC's Division of Community Health

Agency IC Tracking Number:

0920-14AND

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Interview Guide for Videos	Attachment 3_Interview guide for video testing with businesspeople (05-15-14) DCH Video Testing.docx	No		Printable Only
Form	none	Eligibility Screener for Business people	Attachment 4_Eligibility screener for businesspeople (05-15-14) DCH Video Testing.docx	Yes	Yes	Fillable Fileable
Form	none	Survey for Video Testing	Attachment 5_Survey for video testing with awardees (05-15-14) DCH Video Testing.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Expedited Review	HMTS Expedited Review Form (07-01-14) DCH Video Testing.docx	07/09/2014
Research Plan	Attachment 1_Research plan and burden table (5-15-14) DCH Video Testing .docx	07/09/2014
Videos for Testing/Links	Attachment 2_Videos for testing (05-15-14) DCH Video Testing.docx	07/09/2014

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