CDC and ATSDR Health Message Testing System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0572 Survey Instrument for Health Care Providers	Form and Instruction	New	Available
Form 0920-0572 Screening Instrument for Health Care Providers	Form and Instruction	New	Available
Form 0920-0572 Survey Instrument for Young Women	Form and Instruction	New	Available
Form 0920-0572 Screening Instrument for Young Women	Form and Instruction	New	Available
Recruitment screener	Form	New	Available
Caregiver Comparison Worksheet	Form and Instruction	New	Available
Youth Comparison Worksheet	Form and Instruction	New	Available
Caregiver Rating Worksheet	Form and Instruction	New	Available
Youth Rating Worksheet	Form and Instruction	New	Available
Foduc Group Screener	Form and Instruction	New	Available
Sepsis Educational Awareness Assessment	Form	New	Available
Sepsis Assessment - Consumers	Form	New	Available
Be Antibiotics Aware Consumer Survey (BAACS)	Form	New	Available
Participant Screener	Form and Instruction	New	Available
CDC Prescription Opioid Physician Survey	Form	New	Available
Screener and Moderator's Guide for In-person Focus Group Participants	Form and Instruction	New	Available
Screener and Survey for Online Participants (content is provided in screen shots and Word)	Form and Instruction	New	Available
Men/Women Reproductive Age (18-49) - Focus Group Guide	Form and Instruction	New	Available
Community Leader - Focus Group Guide	Form and Instruction	New	Available
Men/Women Reproductive Age (18-49) - Focus Group Screening Instrument	Form and Instruction	New	Available
Community Leader - Focus Group Screening Instrument	Form and Instruction	New	Available
Online Focus Group Guide for Consumers	Form and Instruction	New	Available
Pre-discussion Information Survey for Consumers (Caregiver-demanders and Caregiver-expectors)	Form and Instruction	New	Available
Screener for Consumers (Caregiver-demanders and Caregiver-expectors)	Form and Instruction	New	Available
Screener for Consumers (Self-demanders and Self-expectors)	Form and Instruction	New	Available
Pre-discussion Information Survey for Consumers (Self-demanders and Self-expectors)	Form and Instruction	New	Available
In-Depth Interview Guide for Health Care Professionals	Form and Instruction	New	Available
Pre-Discussion Information Survey for Health Care Professionals	Form and Instruction	New	Available
Screener for Health Care Professionals	Form and Instruction	New	Available
Form Att. F2 Att. F2 Moms book	Form and Instruction	New	Available
Form Att. F1 Att. F1 Dads book	Form and Instruction	New	Available
Screenshots of the Sepsis R2 Survey for Consumers	Form	New	Available
Screenshots of the Sepsis Survey for Healthcare Professionals	Form	New	Available
Focus Group Screener	Form and Instruction	New	Available
Interview Screener	Form and Instruction	New	Available
Digital Ad Response Sheet (completed during focus groups with men)	Form and Instruction	New	Available
Focus Group Discussion Guide for Hispanic Men	Form and Instruction	New	Available
Focus Group Discussion Guide for African American Men	Form and Instruction	New	Available
Focus Group Discussion Guide for Hispanic Women	Form and Instruction	New	Available
Focus Group Discussion Guide for African American Women	Form and Instruction	New	Available
Informed Consent and Rescreening Form	Form and Instruction	New	Available
Screener	Form and Instruction	New	Available
Focus Group Guide	Form and Instruction	New	Available
Focus Group Screener	Form and Instruction	New	Available
Screen Shots of the Prescription Drug Overdose Survey	Form	New	Available
Focus Group Screener	Form and Instruction	New	Available
Bring Your Brave Campaign Testing Survey	Form	New	Available
Form 0920-0572 Attachment 3 consumer IDI Guide_l1_13	Form and Instruction	New	Available
Form 0920-0572 ttachment2 - Consumer Screener for IDICONUS_1_13	Form and Instruction	New	Available
Form 0920-0572 Attachment 7 - FGPRGuide_1-13-17	Form and Instruction	New	Available
Form 0920-0572 Attatchment 6 - FGPRScreener_1_13	Form and Instruction	New	Available
Form 0920-0572 Attachment 5 - Provider Survey_1_13	Form and Instruction	New	Available
Form 0920-0572 Attachment 4 - Provider Screener_1_13	Form and Instruction	New	Available
Intercept interview for message testing	Form and Instruction	New	Available
Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - Spanish	Form and Instruction	New	Available
Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - English	Form and Instruction	New	Available
OADC Message and Material Feedback Survey - Health Material Questions	Form and Instruction	New	Available
OADC Message and Material Feedback Survey - Screener	Form and Instruction	New	Available
Consent - Intercept Survey	Form and Instruction	New	Available
Consent - Consumer Web Survey	Form and Instruction	New	Available
Screener - Consumer Web Survey	Form and Instruction	New	Available
Intercept Guide	Form and Instruction	New	Available
Consumer Web Survey	Form and Instruction	New	Available
Professional - Consent	Form and Instruction	New	Available
Provider - Consent	Form and Instruction	New	Available
Consumer - Consent	Form and Instruction	New	Available
Professional - Screener	Form and Instruction	New	Available
Provider - Screener	Form and Instruction	New	Available
Consumer - Screener	Form and Instruction	New	Available
Professional - Brief Survey	Form and Instruction	New	Available
Provider - Brief Survey	Form and Instruction	New	Available
Consumer - Brief Survey	Form and Instruction	New	Available
Professional IDI Guide	Form and Instruction	New	Available
Professional Focus Group Guide	Form and Instruction	New	Available
Provider IDI Guide	Form and Instruction	New	Available
Provider Focus Group Guide	Form and Instruction	New	Available
Consumer IDI Guide	Form and Instruction	New	Available
Consumer Focus Group Guide	Form and Instruction	New	Available
Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - Spanish	Form and Instruction	New	Available
Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - English	Form and Instruction	New	Available
FOCUS GROUP AND FOLLOW UP FOCUS GROUP INSTRUMENT	Form and Instruction	New	Available
FOCUS GROUP SCREENER AND FOLLOW UP FOCUS GROUP SCREENER	Form and Instruction	New	Available
Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages	Form and Instruction	New	Available
In-depth Interview of Pregnant Women in Puerto Rico To Test Zika Prevention Messages	Form and Instruction	New	Available
In-depth Interview of Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika	Form and Instruction	New	Available
In-depth Interview of Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika	Form and Instruction	New	Available
Focus Group Discussion with Pregnant Women in Puerto Rico To Test Zika Prevention Messages	Form and Instruction	New	Available
Focus Group Discussion with Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika	Form and Instruction	New	Available
Focus Group Discussion with Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika	Form and Instruction	New	Available
SS-Part A HMTS .docx	Supporting Statement A	Uploaded 2015-02-09	Available
Attachment 11 - IRB Ruling 060308.doc	Supplementary Document	Uploaded 2015-02-05	Available
Attachment 10 - Examples-Data Collection Instruments 060308.doc	Supplementary Document	Uploaded 2015-02-05	Available
Attachment 9-FollowUpQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment8-ActivityTaskQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment5-MarketResearchExpQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment7-CoreQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment 6-IntroductoryQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment 4-DemographicQuestions.docx	Supplementary Document	Uploaded 2015-02-05	Available
Attachment 3 - Health Message Testing System Expedited Review Form .docx	Supplementary Document	Uploaded 2015-02-05	Available
60-day FRN.pdf	Supplementary Document	Uploaded 2015-02-05	Available
SS-PartB-HMTS .docx	Supporting Statement B	Uploaded 2015-02-05	Available
Att 1-AuthLegislation.pdf	Supplementary Document	Uploaded 2011-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230309	"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers	Form and Instruction	New	Survey Instrument for Health Care Providers
230309	"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers	Form and Instruction	New	Screening Instrument for Health Care Providers
230309	"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers	Form and Instruction	New	Survey Instrument for Young Women
230309	"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers	Form and Instruction	New	Screening Instrument for Young Women
230289	Air Quality Information Initiative	Other-Focus Group Guide	New
230289	Air Quality Information Initiative	Form	New	Recruitment screener
230191	Asthma Control Communication Materials Field Testing (NCEH)	Form and Instruction	New	Caregiver Comparison Worksheet
230191	Asthma Control Communication Materials Field Testing (NCEH)	Form and Instruction	New	Youth Comparison Worksheet
230191	Asthma Control Communication Materials Field Testing (NCEH)	Form and Instruction	New	Caregiver Rating Worksheet
230191	Asthma Control Communication Materials Field Testing (NCEH)	Form and Instruction	New	Youth Rating Worksheet
230191	Asthma Control Communication Materials Field Testing (NCEH)	Other-Discussion Guide	New
230191	Asthma Control Communication Materials Field Testing (NCEH)	Form and Instruction	New	Foduc Group Screener
229935	Sepsis Educational Awareness Message/Materials Assessment - HCP	Form	New	Sepsis Educational Awareness Assessment
229832	Sepsis Educational Awareness Message/Materials Assessment - Consumers	Form	New	Sepsis Assessment - Consumers
229773	Be Antibiotics Aware Educational Message/Materials Assessment	Form	New	Be Antibiotics Aware Consumer Survey (BAACS)
229714	Older Adult Mobility Planning Brochure	Form and Instruction	New	Participant Screener
229714	Older Adult Mobility Planning Brochure	Instruction	New
228955	Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain	Form	New	CDC Prescription Opioid Physician Survey
228955	Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain	Other-Invitation letter	New
228558	Message Testing with Mothers for CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO)	Form and Instruction	New	Screener and Moderator's Guide for In-person Focus Group Participants
228558	Message Testing with Mothers for CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO)	Form and Instruction	New	Screener and Survey for Online Participants (content is provided in screen shots and Word)
228002	American Academy of Pediatrics Oral Health Toolkit Research and Message Testing	Other-Focus Group Guide	New
227732	Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	Form and Instruction	New	Men/Women Reproductive Age (18-49) - Focus Group Guide
227732	Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	Form and Instruction	New	Community Leader - Focus Group Guide
227732	Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	Form and Instruction	New	Men/Women Reproductive Age (18-49) - Focus Group Screening Instrument
227732	Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	Form and Instruction	New	Community Leader - Focus Group Screening Instrument
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	Form and Instruction	New	Online Focus Group Guide for Consumers
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	Form and Instruction	New	Pre-discussion Information Survey for Consumers (Caregiver-demanders and Caregiver-expectors)
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	Form and Instruction	New	Screener for Consumers (Caregiver-demanders and Caregiver-expectors)
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	Form and Instruction	New	Screener for Consumers (Self-demanders and Self-expectors)
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	Form and Instruction	New	Pre-discussion Information Survey for Consumers (Self-demanders and Self-expectors)
227266	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals	Form and Instruction	New	In-Depth Interview Guide for Health Care Professionals
227266	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals	Form and Instruction	New	Pre-Discussion Information Survey for Health Care Professionals
227266	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals	Form and Instruction	New	Screener for Health Care Professionals
227066	Focus Group Research to Inform the Development of Mesages to change Social Norms	Form and Instruction	New	Att. F2 Moms book
227066	Focus Group Research to Inform the Development of Mesages to change Social Norms	Form and Instruction	New	Att. F1 Dads book
227066	Focus Group Research to Inform the Development of Mesages to change Social Norms	Instruction	New
227054	Sepsis Campaign Development: Round 2 Concept/Materials Testing for Consumers	Form	New	Screenshots of the Sepsis R2 Survey for Consumers
227053	Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers	Form	New	Screenshots of the Sepsis Survey for Healthcare Professionals
227003	Radiation Concepts/Comparison Message Testing	Other-Moderator's Guide	New
227003	Radiation Concepts/Comparison Message Testing	Form and Instruction	New	Focus Group Screener
227003	Radiation Concepts/Comparison Message Testing	Form and Instruction	New	Interview Screener
226565	Re-entry Messaging Following a Radiation Emergency	Other-WORD	New
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Digital Ad Response Sheet (completed during focus groups with men)
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Focus Group Discussion Guide for Hispanic Men
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Focus Group Discussion Guide for African American Men
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Focus Group Discussion Guide for Hispanic Women
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Focus Group Discussion Guide for African American Women
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Informed Consent and Rescreening Form
226499	Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	Form and Instruction	New	Screener
226496	Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials	Form and Instruction	New	Focus Group Guide
226496	Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials	Form and Instruction	New	Focus Group Screener
226286	Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign	Other-Overview of Questions in the PDO Survey	New
226286	Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign	Form	New	Screen Shots of the Prescription Drug Overdose Survey
226047	Asthma Control Initiative Communication Messaging and Materials Development	Form and Instruction	New	Focus Group Screener
226047	Asthma Control Initiative Communication Messaging and Materials Development	Other-Focus Group Guide	New
225789	Bring Your Brave Campaign Message Testing	Form	New	Bring Your Brave Campaign Testing Survey
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	Attachment 3 consumer IDI Guide_l1_13
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	ttachment2 - Consumer Screener for IDICONUS_1_13
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	Attachment 7 - FGPRGuide_1-13-17
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	Attatchment 6 - FGPRScreener_1_13
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	Attachment 5 - Provider Survey_1_13
225268	Domestic Readiness Initiative on Zika Virus Disease	Form and Instruction	New	Attachment 4 - Provider Screener_1_13
224378	Message Testing among Public Audiences in US Virgin Islands for Zika prevention	Form and Instruction	New	Intercept interview for message testing
222786	GenIC Testing of Spanish-language Messages for the National Diabetes	Other-WORD	New
222248	Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages	Form and Instruction	New	Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - Spanish
222248	Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages	Form and Instruction	New	Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - English
221858	Office of the Associate Director for Communication (OADC) Message and Material Feedback	Form and Instruction	New	OADC Message and Material Feedback Survey - Health Material Questions
221858	Office of the Associate Director for Communication (OADC) Message and Material Feedback	Form and Instruction	New	OADC Message and Material Feedback Survey - Screener
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consent - Intercept Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consent - Consumer Web Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Screener - Consumer Web Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Intercept Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer Web Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Professional - Consent
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Provider - Consent
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer - Consent
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Professional - Screener
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Provider - Screener
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer - Screener
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Professional - Brief Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Provider - Brief Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer - Brief Survey
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Professional IDI Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Professional Focus Group Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Provider IDI Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Provider Focus Group Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer IDI Guide
221856	High Impact Prevention Message Testing (HIPMT)	Form and Instruction	New	Consumer Focus Group Guide
221594	Message testing among partners of pregnant women in Puerto Rico	Form and Instruction	New	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - Spanish
221594	Message testing among partners of pregnant women in Puerto Rico	Form and Instruction	New	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - English
221338	HEADS UP Audience Research Study	Form and Instruction	New	FOCUS GROUP AND FOLLOW UP FOCUS GROUP INSTRUMENT
221338	HEADS UP Audience Research Study	Form and Instruction	New	FOCUS GROUP SCREENER AND FOLLOW UP FOCUS GROUP SCREENER
221272	HMTS - Message testing among important public audiences in Puerto Rico	Form and Instruction	New	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages
221070	CDC/NCEH TO21: Outdoor Air Quality Focus Group	Other-WORD	New
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	In-depth Interview of Pregnant Women in Puerto Rico To Test Zika Prevention Messages
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	In-depth Interview of Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	In-depth Interview of Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	Focus Group Discussion with Pregnant Women in Puerto Rico To Test Zika Prevention Messages
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	Focus Group Discussion with Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika
220252	HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	Form and Instruction	New	Focus Group Discussion with Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 201502-0920-001
Status: Historical Active	Previous ICR Reference No: 201501-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/30/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/11/2015
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	55,575	0	55,575
Time Burden (Hours)	7,410	0	7,510
Cost Burden (Dollars)	0	0	0

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Abstract: CDC must communicate about hazards, outbreaks and other emergencies that present an urgent health threat to the public. Untested messages can waste communication resources and opportunities because the messages can be perceived as unclear or irrelevant. OADC-CDC requests an extension for the generic clearance for an expedited review of items to be used in health message testing to ensure the public will understand health messages and take recommended action.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69478	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 7477	02/10/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 34

table that charts list of burden

IC Title	Form No.	Form Name
"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers	0920-0572, 0920-0572, 0920-0572, 0920-0572	Screening Instrument for Young Women ,   Survey Instrument for Young Women ,   Screening Instrument for Health Care Providers ,   Survey Instrument for Health Care Providers
Air Quality Information Initiative	none	Recruitment screener
American Academy of Pediatrics Oral Health Toolkit Research and Message Testing
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	n/a, n/a, n/a, n/a, n/a	Screener for Consumers (Self-demanders and Self-expectors) ,   Screener for Consumers (Caregiver-demanders and Caregiver-expectors) ,   Pre-discussion Information Survey for Consumers (Self-demanders and Self-expectors) ,   Pre-discussion Information Survey for Consumers (Caregiver-demanders and Caregiver-expectors) ,   Online Focus Group Guide for Consumers
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals	n/a, n/a, n/a	Screener for Health Care Professionals ,   Pre-Discussion Information Survey for Health Care Professionals ,   In-Depth Interview Guide for Health Care Professionals
Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain	none	CDC Prescription Opioid Physician Survey
Asthma Control Communication Materials Field Testing (NCEH)	none, none, none, none, none	Foduc Group Screener ,   Youth Rating Worksheet ,   Caregiver Rating Worksheet ,   Youth Comparison Worksheet ,   Caregiver Comparison Worksheet
Asthma Control Initiative Communication Messaging and Materials Development	none	Focus Group Screener
Be Antibiotics Aware Educational Message/Materials Assessment	n/a	Be Antibiotics Aware Consumer Survey (BAACS)
Bring Your Brave Campaign Message Testing	none	Bring Your Brave Campaign Testing Survey
CDC/NCEH TO21: Outdoor Air Quality Focus Group
Domestic Readiness Initiative on Zika Virus Disease	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Attachment 4 - Provider Screener_1_13 ,   Attachment 5 - Provider Survey_1_13 ,   Attatchment 6 - FGPRScreener_1_13 ,   Attachment 7 - FGPRGuide_1-13-17 ,   ttachment2 - Consumer Screener for IDICONUS_1_13 ,   Attachment 3 consumer IDI Guide_l1_13
Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials	NA, NA	Focus Group Screener ,   Focus Group Guide
Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing	NA, NA, NA, NA	Community Leader - Focus Group Screening Instrument ,   Men/Women Reproductive Age (18-49) - Focus Group Screening Instrument ,   Community Leader - Focus Group Guide ,   Men/Women Reproductive Age (18-49) - Focus Group Guide
Focus Group Research to Inform the Development of Mesages to change Social Norms	Att. F2, Att. F1	Att. F1 Dads book ,   Att. F2 Moms book
GenIC Testing of Spanish-language Messages for the National Diabetes
HEADS UP Audience Research Study	NA, NA	FOCUS GROUP SCREENER AND FOLLOW UP FOCUS GROUP SCREENER ,   FOCUS GROUP AND FOLLOW UP FOCUS GROUP INSTRUMENT
HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico	NA, NA, NA, NA, NA, NA	Focus Group Discussion with Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika ,   Focus Group Discussion with Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika ,   Focus Group Discussion with Pregnant Women in Puerto Rico To Test Zika Prevention Messages ,   In-depth Interview of Community Leaders in Puerto Rico to Explore Possible Actions for Preventing Zika ,   In-depth Interview of Pregnant Women in Puerto Rico to Explore Possible Actions for Preventing Zika ,   In-depth Interview of Pregnant Women in Puerto Rico To Test Zika Prevention Messages
HMTS - Message testing among important public audiences in Puerto Rico	NA	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages
High Impact Prevention Message Testing (HIPMT)	NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA, NA	Consumer Focus Group Guide ,   Consumer IDI Guide ,   Provider Focus Group Guide ,   Provider IDI Guide ,   Professional Focus Group Guide ,   Professional IDI Guide ,   Consumer - Brief Survey ,   Provider - Brief Survey ,   Professional - Brief Survey ,   Consumer - Screener ,   Provider - Screener ,   Professional - Screener ,   Consumer - Consent ,   Provider - Consent ,   Professional - Consent ,   Consumer Web Survey ,   Intercept Guide ,   Screener - Consumer Web Survey ,   Consent - Consumer Web Survey ,   Consent - Intercept Survey
Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages	NA, NA	Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - English ,   Intercept Interviews with Public Audiences in Puerto Rico To Test Zika Prevention Messages - Spanish
Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign	N/A	Screen Shots of the Prescription Drug Overdose Survey
Message Testing among Public Audiences in US Virgin Islands for Zika prevention	none	Intercept interview for message testing
Message Testing with Mothers for CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO)	n/a, n/a	Screener and Survey for Online Participants (content is provided in screen shots and Word) ,   Screener and Moderator's Guide for In-person Focus Group Participants
Message testing among partners of pregnant women in Puerto Rico	NA, NA	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - English ,   Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages - Spanish
Office of the Associate Director for Communication (OADC) Message and Material Feedback	NA, NA	OADC Message and Material Feedback Survey - Screener ,   OADC Message and Material Feedback Survey - Health Material Questions
Older Adult Mobility Planning Brochure	none	Participant Screener
Radiation Concepts/Comparison Message Testing	none, none	Interview Screener ,   Focus Group Screener
Re-entry Messaging Following a Radiation Emergency
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Consumers	n/a	Screenshots of the Sepsis R2 Survey for Consumers
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers	n/a	Screenshots of the Sepsis Survey for Healthcare Professionals
Sepsis Educational Awareness Message/Materials Assessment - Consumers	none	Sepsis Assessment - Consumers
Sepsis Educational Awareness Message/Materials Assessment - HCP	none	Sepsis Educational Awareness Assessment
Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival	N/A, N/A, N/A, N/A, N/A, N/A, N/A	Screener ,   Informed Consent and Rescreening Form ,   Focus Group Discussion Guide for African American Women ,   Focus Group Discussion Guide for Hispanic Women ,   Focus Group Discussion Guide for African American Men ,   Focus Group Discussion Guide for Hispanic Men ,   Digital Ad Response Sheet (completed during focus groups with men)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,575	55,575	0	0	0	0
Annual Time Burden (Hours)	7,410	7,510	0	-100	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden change reverts estimated numbers back to original ICR; additional hours were added previously due to an unusually burdensome genIC.

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Annual Cost to Federal Government: $1,550,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/11/2015

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