Information Collection

Air Quality Information Initiative

IC 230289 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⚠️ Notice: This information collection may be referencing outdated material.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
Air Quality Information Initiative	Form
Attachment C_Moderator Guide_20180227.docx	Other-Focus Group Guide
Recruitment screener Attachment A_Recruitment Screener_20180227.docx	Form
Attachment B_Informed Consent Form_20180227.docx Consent	IC Document
Attachment D_Participant Contact Information_20180227.docx Contact information	IC Document
Project Description_Air Quality Information Initiative_20180227.docx Project Description	IC Document
HMTS Expedited Review Form - Air Quality Information Initiative_20180227.pdf HTMS Review Form	IC Document
Message1_Air Quality Information Initiative.pdf Message 1	IC Document
Message2_Air Quality Information Initiative.pdf Message 2	IC Document
Message3_Air Quality Information Initiative.pdf Message 3	IC Document

IC Title:

Air Quality Information Initiative

Agency IC Tracking Number:

0920-0572-18LD

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
Form	none	Recruitment screener	Attachment A_Recruitment Screener_20180227.docx		Yes	Yes	Fillable Fileable
Other-Focus Group Guide			Attachment C_Moderator Guide_20180227.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 108

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	108	108
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent	Attachment B_Informed Consent Form_20180227.docx	02/28/2018
Contact information	Attachment D_Participant Contact Information_20180227.docx	02/28/2018
Project Description	Project Description_Air Quality Information Initiative_20180227.docx	02/28/2018
HTMS Review Form	HMTS Expedited Review Form - Air Quality Information Initiative_20180227.pdf	02/28/2018
Message 1	Message1_Air Quality Information Initiative.pdf	02/28/2018
Message 2	Message2_Air Quality Information Initiative.pdf	02/28/2018
Message 3	Message3_Air Quality Information Initiative.pdf	02/28/2018

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