CDC and ATSDR Health Message Testing System

Forms and Documents

Document Name	Status
Form 0920-0572 "Bring Your Brave" Campaign Messages for Young Women and Health Care Providers Form and Instruction	New
Air Quality Information Initiative Form	New
Asthma Control Communication Materials Field Testing (NCEH) Form and Instruction	New
Sepsis Educational Awareness Message/Materials Assessment - HCP Form	New
Sepsis Educational Awareness Message/Materials Assessment - Consumers Form	New
Be Antibiotics Aware Educational Message/Materials Assessment Form	New
Message Testing with Mothers for CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO) Form and Instruction	New
Domestic Readiness Initiative on Zika Virus Disease: Year 2 Message & Materials Testing Form and Instruction	New
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers Form and Instruction	New
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals Form and Instruction	New
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Consumers Form	New
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers Form	New
Radiation Concepts/Comparison Message Testing Form and Instruction	New
Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival Form and Instruction	New
Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials Form and Instruction	New
Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign Form	New
Bring Your Brave Campaign Message Testing Form	New
Form 0920-0572 Domestic Readiness Initiative on Zika Virus Disease Form and Instruction	New
Message Testing among Public Audiences in US Virgin Islands for Zika prevention Form and Instruction	New
Intercept Interviews with Travelers in Puerto Rico To Test Zika Prevention Messages Form and Instruction	New
Office of the Associate Director for Communication (OADC) Message and Material Feedback Form and Instruction	New
High Impact Prevention Message Testing (HIPMT) Form and Instruction	New
Message testing among partners of pregnant women in Puerto Rico Form and Instruction	New
HEADS UP Audience Research Study Form and Instruction	New
HMTS - Message testing among important public audiences in Puerto Rico Form and Instruction	New
HMTS - Formative evaluation of Zika prevention strategies and messages among pregnant women and community leaders in Puerto Rico Form and Instruction	New
SS-Part A HMTS .docx Supporting Statement A	2015-02-09
Attachment 11 - IRB Ruling 060308.doc Supplementary Document	2015-02-05
Attachment 10 - Examples-Data Collection Instruments 060308.doc Supplementary Document	2015-02-05
Attachment 9-FollowUpQuestions.docx Supplementary Document	2015-02-05
Attachment8-ActivityTaskQuestions.docx Supplementary Document	2015-02-05
Attachment5-MarketResearchExpQuestions.docx Supplementary Document	2015-02-05
Attachment7-CoreQuestions.docx Supplementary Document	2015-02-05
Attachment 6-IntroductoryQuestions.docx Supplementary Document	2015-02-05
Attachment 4-DemographicQuestions.docx Supplementary Document	2015-02-05
Attachment 3 - Health Message Testing System Expedited Review Form .docx Supplementary Document	2015-02-05
60-day FRN.pdf Supplementary Document	2015-02-05
SS-PartB-HMTS .docx Supporting Statement B	2015-02-05
Att 1-AuthLegislation.pdf Supplementary Document	2011-11-09

IC Document Collections

IC ID	Document Title	Status
230309	"Bring Your Brave" Campaign Messages for Young Women and Health Care Providers Form and Instruction	New
230289	Air Quality Information Initiative Form	New
230191	Asthma Control Communication Materials Field Testing (NCEH) Form and Instruction	New
229935	Sepsis Educational Awareness Message/Materials Assessment - HCP Form	New
229832	Sepsis Educational Awareness Message/Materials Assessment - Consumers Form	New
229773	Be Antibiotics Aware Educational Message/Materials Assessment Form	New
229714	Older Adult Mobility Planning Brochure Instruction	New
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
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
227267	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers Form and Instruction	New
227266	Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Health Care Professionals Form and Instruction	New
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
227053	Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers Form	New
227003	Radiation Concepts/Comparison Message Testing Form and Instruction	New
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
226496	Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials Form and Instruction	New
226286	Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign Form	New
226047	Asthma Control Initiative Communication Messaging and Materials Development Other-Focus Group Guide	New
225789	Bring Your Brave Campaign Message Testing Form	New
225268	Domestic Readiness Initiative on Zika Virus Disease Form and Instruction	New
224378	Message Testing among Public Audiences in US Virgin Islands for Zika prevention Form and Instruction	New
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
221858	Office of the Associate Director for Communication (OADC) Message and Material Feedback Form and Instruction	New
221856	High Impact Prevention Message Testing (HIPMT) Form and Instruction	New
221594	Message testing among partners of pregnant women in Puerto Rico Form and Instruction	New
221338	HEADS UP Audience Research Study Form and Instruction	New
221272	HMTS - Message testing among important public audiences in Puerto Rico Form and Instruction	New
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

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
	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.

	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

IC Title	Form No.	Form Name
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
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
Asthma Control Initiative Communication Messaging and Materials Development	none	Focus Group Screener
GenIC Testing of Spanish-language Messages for the National Diabetes
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
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
Bring Your Brave Campaign Message Testing	none	Bring Your Brave Campaign Testing Survey
HEADS UP Audience Research Study	NA, NA	FOCUS GROUP SCREENER AND FOLLOW UP FOCUS GROUP SCREENER ,   FOCUS GROUP AND FOLLOW UP FOCUS GROUP INSTRUMENT
Air Quality Information Initiative	none	Recruitment screener
Domestic Readiness Initiative on Zika Virus Disease - Year 2 Core Campaign Materials	NA, NA	Focus Group Screener ,   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
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
Re-entry Messaging Following a Radiation Emergency
Older Adult Mobility Planning Brochure	none	Participant Screener
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
CDC/NCEH TO21: Outdoor Air Quality Focus Group
"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
Sepsis Educational Awareness Message/Materials Assessment - HCP	none	Sepsis Educational Awareness Assessment
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Healthcare Providers	n/a	Screenshots of the Sepsis Survey for Healthcare Professionals
HMTS - Message testing among important public audiences in Puerto Rico	NA	Intercept Interviews with Public Audiences in Puerto Rico to test Zika Prevention Messages
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
Sepsis Educational Awareness Message/Materials Assessment - Consumers	none	Sepsis Assessment - Consumers
Radiation Concepts/Comparison Message Testing	none, none	Interview Screener ,   Focus Group Screener
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
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
Assess Perception and Use of CDC Guideline for Prescribing Opioids for Chronic Pain	none	CDC Prescription Opioid Physician Survey
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)
Antibiotic Use Campaign: Round 2 (R2) Concept/Materials Testing with Consumers	n/a, n/a, n/a, n/a, n/a	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 ,   Screener for Consumers (Self-demanders and Self-expectors) ,   Screener for Consumers (Caregiver-demanders and Caregiver-expectors)
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
Message Testing among Public Audiences in US Virgin Islands for Zika prevention	none	Intercept interview for message testing
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
Be Antibiotics Aware Educational Message/Materials Assessment	n/a	Be Antibiotics Aware Consumer Survey (BAACS)
Sepsis Campaign Development: Round 2 Concept/Materials Testing for Consumers	n/a	Screenshots of the Sepsis R2 Survey for Consumers
American Academy of Pediatrics Oral Health Toolkit Research and Message Testing

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ICR Summary 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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