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

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.