Information Collection

CDC's Inside Knowledge Campaign: 2018 Focus Group Research and Testing with the General Public and Hispanic Audiences

IC 231332 under ICR 201610-0920-009 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CDC's Inside Knowledge Campaign: 2018 Focus Group Research and Testing with the General Public and Hispanic Audiences	Form and Instruction
English Language Screening Instrument Attachment 2a_IK2017_Screener_ENG_03012018.docx	Form and Instruction
Spanish Language Screening Instrument Attachment 2b_IK2017_Screener_SPN1_03012018.docx	Form and Instruction
English Language Focus Group Discussion Guide Attachment 1a_IK2017_ModGuide_English_03012018.docx	Form and Instruction
Spanish Language Focus Group Discussion Guide Attachment 1b_IK2017_ModGuide_Spanish_03012018.docx	Form and Instruction
Attachment 3a_Consent Form English081017_05042018.doc English Language Consent Form	IC Document
Attachment 3b_Consent Form Spanish081017_05042018.docx Spanish Language Consent Form	IC Document
Attachment 4_Creative Concepts Brief_081017_05042018.doc Creative Concepts Brief	IC Document
Attachment5_684_IRB_Form_03012018.pdf Documentation - Not Research Involving Human Subjects (no IRB approval required)	IC Document
GenICRequestTemplate 0920-1154_03012018_05042018.docx GENIC Template	IC Document
IK2018_SSA_03012018_05042018.doc Supporting Statement Part A	IC Document
IK2018_SSB_03012018_05042018.docx Supporting Statement Part B	IC Document

IC Title:

CDC's Inside Knowledge Campaign: 2018 Focus Group Research and Testing with the General Public and Hispanic Audiences

Agency IC Tracking Number:

0920-18KY

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	Available Electronically?	Electronic Capability
Form and Instruction	n/a	English Language Screening Instrument	Attachment 2a_IK2017_Screener_ENG_03012018.docx	No	Paper Only
Form and Instruction	n/a	Spanish Language Screening Instrument	Attachment 2b_IK2017_Screener_SPN1_03012018.docx	No	Paper Only
Form and Instruction	n/a	English Language Focus Group Discussion Guide	Attachment 1a_IK2017_ModGuide_English_03012018.docx	No	Paper Only
Form and Instruction	n/a	Spanish Language Focus Group Discussion Guide	Attachment 1b_IK2017_ModGuide_Spanish_03012018.docx	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 576

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	576	576
Annual IC Time Burden (Hours)	720	720
Annual IC Cost Burden (Dollars)	18,821	18,821

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
English Language Consent Form	Attachment 3a_Consent Form English081017_05042018.doc	05/04/2018
Spanish Language Consent Form	Attachment 3b_Consent Form Spanish081017_05042018.docx	05/04/2018
Creative Concepts Brief	Attachment 4_Creative Concepts Brief_081017_05042018.doc	05/04/2018
Documentation - Not Research Involving Human Subjects (no IRB approval required)	Attachment5_684_IRB_Form_03012018.pdf	05/04/2018
GENIC Template	GenICRequestTemplate 0920-1154_03012018_05042018.docx	05/04/2018
Supporting Statement Part A	IK2018_SSA_03012018_05042018.doc	05/04/2018
Supporting Statement Part B	IK2018_SSB_03012018_05042018.docx	05/04/2018

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