Information Collection

Asthma Control Initiative Communication Messaging and Materials Development

IC 226047 under ICR 201502-0920-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Attachment 2_Focus Group Discussion Guide.docx Other-Focus Group Guide
Focus Group Screener Attachment 1_Focus Group Screener.doc Form and Instruction
HMTS Expedited Review Form-Asthma Control Initiative Communication Messaging and Materials Development.docx Request for Approval IC Document
Attachment 3_Focus Group Worksheet.pdf Focus Group Worksheet IC Document
Attachment 4_Focus Group Caregiver for Youth Consent Form.docx Caregiver Consent IC Document
Attachment 5_Focus Group Youth Assent Form_AEcomments.docx Youth Assent IC Document
Attachment 6_Focus Group Caregiver Consent Form.docx Focus Group Consent IC Document
Attachment 7_Focus Group Confirmation Email.docx Confirmation Email IC Document
Attachment 8_Focus Group Reminder Email.docx Reminder Email IC Document
OMB Protocol_Asthma Control Initiative Communication Messaging Materials Development.docx Project Protocol IC Document
Attachment 9 asthma_brochure.pdf Asthma Brochure IC Document
Attachment 10 Management.pdf Asthma Treatment IC Document
Attachment 11 Triggers.pdf Asthma Triggers IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Asthma Control Initiative Communication Messaging and Materials Development	Agency IC Tracking Number:	17YA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Focus Group Guide			Attachment 2_Focus Group Discussion Guide.docx		Yes	No	Paper Only
Form and Instruction	none	Focus Group Screener	Attachment 1_Focus Group Screener.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 336	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	336	336
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	HMTS Expedited Review Form-Asthma Control Initiative Communication Messaging and Materials Development.docx	03/15/2017
Focus Group Worksheet	Attachment 3_Focus Group Worksheet.pdf	03/15/2017
Caregiver Consent	Attachment 4_Focus Group Caregiver for Youth Consent Form.docx	03/15/2017
Youth Assent	Attachment 5_Focus Group Youth Assent Form_AEcomments.docx	03/15/2017
Focus Group Consent	Attachment 6_Focus Group Caregiver Consent Form.docx	03/15/2017
Confirmation Email	Attachment 7_Focus Group Confirmation Email.docx	03/15/2017
Reminder Email	Attachment 8_Focus Group Reminder Email.docx	03/15/2017
Project Protocol	OMB Protocol_Asthma Control Initiative Communication Messaging Materials Development.docx	03/15/2017
Asthma Brochure	Attachment 9 asthma_brochure.pdf	03/15/2017
Asthma Treatment	Attachment 10 Management.pdf	03/15/2017
Asthma Triggers	Attachment 11 Triggers.pdf	03/15/2017

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