Information Collection

Behavioral Determinants of Community Hand Hygiene Behavior: A Formative Qualitative Evaluation

IC 231343 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1154 Behavioral Determinants of Community Hand Hygiene Behavior: A Formative Qualitative Evaluation	Form
0920-1154 Online Screener Att 2 - Screening Form.docx	Form
0920-1154 Focus Group Moderator Guide Att 5 - Focus Group Moderator Guide.docx	Form and Instruction
Att 1 - Recruitment Flyer.docx Recruitment Flyer	IC Document
Att 3 - Notification Scripts.docx Notification Scripts	IC Document
Att 4 - Consent Form.docx Consent Form	IC Document
Att 6 - Reminder.docx Reminder Email	IC Document
Att 7 - NRD.PDF Non-Research Determination	IC Document
SSA_Formative_5.2.18.docx Supporting Statement A	IC Document
SSB_Formative_5.2.18.docx Supporting Statement B	IC Document

IC Title:

Behavioral Determinants of Community Hand Hygiene Behavior: A Formative Qualitative Evaluation

Agency IC Tracking Number:

0920-1154-18AEH

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	0920-1154	Online Screener	Att 2 - Screening Form.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Focus Group Moderator Guide	Att 5 - Focus Group Moderator Guide.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	520	520
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Flyer	Att 1 - Recruitment Flyer.docx	05/08/2018
Notification Scripts	Att 3 - Notification Scripts.docx	05/08/2018
Consent Form	Att 4 - Consent Form.docx	05/08/2018
Reminder Email	Att 6 - Reminder.docx	05/08/2018
Non-Research Determination	Att 7 - NRD.PDF	05/08/2018
Supporting Statement A	SSA_Formative_5.2.18.docx	05/08/2018
Supporting Statement B	SSB_Formative_5.2.18.docx	05/08/2018

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