Information Collection

Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign

IC 226286 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⚠️ Notice: This information collection may be referencing outdated material.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
Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign Form
Att A Instrument PDO.docx Other-Overview of Questions in the P
Screen Shots of the Prescription Drug Overdose Survey Att B PDO PCS Screen Shots 0572.pdf Form
Att E1 PDO_Radio_AnnMarie_12.16.16_ForDistribution.mp3 Radio Ad (Ann Marie) IC Document
Att E2 PDO_Radio_Judy_12.15.16_ForDistribution.mp3 Radio Ad (Judy) IC Document
Att E3 PDO_Radio_Mike_12.16.16_ForDistribution.mp3 Radio Ad (Mike) IC Document
Att E4 PDO_Radio_Noah_12.16.16_ForDistribution.mp3 Radio Ad (Noah) IC Document
Att E5 PDO_Radio_Tamera_12.15.16_ForDistribution.mp3 Radio Ad (Tamera) IC Document
Att E6 PDO Billboard.png PDO Billboard Ad IC Document
Att E7 PDO Web Banner.jpg PDO Web Banner IC Document
Att E8 PDO Web Banner_ANIMATED.gif PDO Animated Web Banner IC Document
1. PDO_HMTSExpeditedReviewForm.pdf HMTS Review Form for the PDO Interim Assessment IC Document
Att D PDO Project Description.docx Project Description IC Document
Att C. Privacy Act.pdf Privacy Act Determination IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interim Assessment of Messages for the Prescription Drug Overdose Prevention, Awareness, and Knowledge Building Campaign	Agency IC Tracking Number:	0920-17ACG

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
Form	N/A	Screen Shots of the Prescription Drug Overdose Survey	Att B PDO PCS Screen Shots 0572.pdf		Yes	Yes	Fillable Fileable
Other-Overview of Questions in the PDO Survey			Att A Instrument PDO.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,430	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,430	1,430
Annual IC Time Burden (Hours)	358	358
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Radio Ad (Ann Marie)	Att E1 PDO_Radio_AnnMarie_12.16.16_ForDistribution.mp3	04/05/2017
Radio Ad (Judy)	Att E2 PDO_Radio_Judy_12.15.16_ForDistribution.mp3	04/05/2017
Radio Ad (Mike)	Att E3 PDO_Radio_Mike_12.16.16_ForDistribution.mp3	04/05/2017
Radio Ad (Noah)	Att E4 PDO_Radio_Noah_12.16.16_ForDistribution.mp3	04/05/2017
Radio Ad (Tamera)	Att E5 PDO_Radio_Tamera_12.15.16_ForDistribution.mp3	04/05/2017
PDO Billboard Ad	Att E6 PDO Billboard.png	04/05/2017
PDO Web Banner	Att E7 PDO Web Banner.jpg	04/05/2017
PDO Animated Web Banner	Att E8 PDO Web Banner_ANIMATED.gif	04/05/2017
HMTS Review Form for the PDO Interim Assessment	1. PDO_HMTSExpeditedReviewForm.pdf	04/05/2017
Project Description	Att D PDO Project Description.docx	04/05/2017
Privacy Act Determination	Att C. Privacy Act.pdf	04/05/2017

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