Information Collection

CHMC-Testing Educational Campaign Materials with African American and Hispanic Audiences

IC 214497 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⚠️ Notice: This information collection may be referencing outdated material.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.pdf	Other-PDF
Attachment 3.pdf	Other-PDF
Attachment 4.pdf	Other-PDF
Attachment 1.pdf Attachment 1 – Testing Plan and Burden Hours Table	IC Document
HMTS Expedited Review Form 12 18 2014.docx Health Message Testing System Expedited Review Form	IC Document
List of Attachments.pdf List of Attachments	IC Document

IC Title:

CHMC-Testing Educational Campaign Materials with African American and Hispanic Audiences

Agency IC Tracking Number:

15IR

IC Status: New

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-PDF	Attachment 2.pdf	Yes	Yes	Fillable Printable
Other-PDF	Attachment 3.pdf	Yes	Yes	Fillable Printable
Other-PDF	Attachment 4.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,800	3,800
Annual IC Time Burden (Hours)	1,584	1,584
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1 â Testing Plan and Burden Hours Table	Attachment 1.pdf	01/07/2015
Health Message Testing System Expedited Review Form	HMTS Expedited Review Form 12 18 2014.docx	01/07/2015
List of Attachments	List of Attachments.pdf	01/07/2015

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