American Academy of Pediatrics Oral Health Toolkit Research and Message Testing

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material.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 B FG Guide New and Expectant Mothers_081017.docx Other-Focus Group Guide
HMTS_Expedited_Review_Form_cb_Revised_081017.docx HTMS Review Form IC Document
ATTACHMENT A Informed Consent form rbk 082317.docx Consent IC Document
ATTACHMENT C Materials for testing_081017.docx Materials for Testing IC Document

Information Collection (IC) Details

IC Title:	American Academy of Pediatrics Oral Health Toolkit Research and Message Testing	Agency IC Tracking Number:	0920-0572-17AZY

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 B FG Guide New and Expectant Mothers_081017.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HTMS Review Form	HMTS_Expedited_Review_Form_cb_Revised_081017.docx	08/28/2017
Consent	ATTACHMENT A Informed Consent form rbk 082317.docx	08/28/2017
Materials for Testing	ATTACHMENT C Materials for testing_081017.docx	08/28/2017

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