Information Collection

National Recovery Month's Public Service Announcements

IC 228001 under ICR 201608-0930-002 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Recruting and Scre National Recovery Month's Public Service Announcements	Form and Instruction
Recruting and Scre Recruting and Screening - English ATTACHMENT A_RM_2017 Recruiting and Screening Questionnaire - 8_21_17.docx	Form and Instruction
Recruting and Scre Recruting and Screening - Spanish ATTACHMENT D_RM_2017 Spanish_Screening questionaire 8_21_17.docx	Form and Instruction
ATTACHMENT B_RM_ 2017 English Moderator's Guide -8_21_17.docx English Moderators Guide	IC Document
ATTACHMENT E_RM_2017_Spanish_Moderator's_Guide 8_21_17.docx Spanish Moderators Guide	IC Document
ATTACHMENT C_RM_2017 RM Consent Form ENG - 8_21_17.docx English Consent Form	IC Document
ATTACHMENT F_RM 2017 Spanish Consent form SPA_08_21_17.docx Spanish Consent Form	IC Document
CSAT RM Focus Groups - 2017 OMB Supporting Statement_ 8_21_17.docx Supporting Statement	IC Document
TransLet-4doc.doc Memo	IC Document

IC Title:

National Recovery Month's Public Service Announcements

Agency IC Tracking Number:

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 and Instruction	Recruting and Screening - English	Recruting and Screening - English	ATTACHMENT A_RM_2017 Recruiting and Screening Questionnaire - 8_21_17.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Recruting and Screening - Spanish	Recruting and Screening - Spanish	ATTACHMENT D_RM_2017 Spanish_Screening questionaire 8_21_17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
English Moderators Guide	ATTACHMENT B_RM_ 2017 English Moderator's Guide -8_21_17.docx	08/23/2017
Spanish Moderators Guide	ATTACHMENT E_RM_2017_Spanish_Moderator's_Guide 8_21_17.docx	08/23/2017
English Consent Form	ATTACHMENT C_RM_2017 RM Consent Form ENG - 8_21_17.docx	08/23/2017
Spanish Consent Form	ATTACHMENT F_RM 2017 Spanish Consent form SPA_08_21_17.docx	08/23/2017
Supporting Statement	CSAT RM Focus Groups - 2017 OMB Supporting Statement_ 8_21_17.docx	08/24/2017
Memo	TransLet-4doc.doc	08/24/2017

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