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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.