Air Quality Information Initiative

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.