Information Collection

Rapid Message Testing with Consumer Panel - Vaccines and Seniors Brochure

IC 231318 under ICR 201712-0910-001 · OMB 0910-0695.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0695 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Recruiting Screener.docx	Other-Survey
Informed Consent Form.docx	Other-Consent Form
Vaccines and Seniors Trifold Brochure.pdf	Other-Brochure
0695 OMB approval memo for Vaccines and Seniors Brochure.docx OMB approval memo	IC Document

IC Title:

Rapid Message Testing with Consumer Panel - Vaccines and Seniors Brochure

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Recruiting Screener.docx	Yes	No	Paper Only
Other-Consent Form	Informed Consent Form.docx	Yes	No	Paper Only
Other-Brochure	Vaccines and Seniors Trifold Brochure.pdf	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

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	250	250
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB approval memo	0695 OMB approval memo for Vaccines and Seniors Brochure.docx	05/02/2018

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