Information Collection

HHS COVID-19 Public Education Campaign Parent & Teen Interview Dyads

IC 248856 under ICR 201803-0990-002 · OMB 0990-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0281 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A_BRANY Approved- HHS COVID-19 Public Education Campaign_Parent Teen Dyads_Discussion Guide - Both Vaccinated_07-26-2	Other-Attachment A Guide
Attachment B_BRANY Approved- HHS COVID-19 Public Education Campaign_Parent Teen Dyads_Discussion Guide - Parent Hesitant on Teen	Other-Attachment B Guide
Attachment C_BRANY Approved- HHS COVID-19 Public Education Campaign_Parent Teen Dyads_Screener - Both Vaccinated_7-26-21_FINAL.pdf Attachment C BRANY Screener	IC Document
Attachment D_BRANY Approved- HHS COVID-19 Public Education Campaign_Parent Teen Dyads_Screener - Parent Hesitant on Teen Vaxx_7-26-21_FINAL.pdf Attachment D BRANY Screener	IC Document
Attachment E_BRANY Approved- Parent Teen Dyads_Parent Consent Form (English)_08-04-21_clean.pdf Attachment E BRANY Consent Form	IC Document
Attachment F_BRANY Approved- Parent Teen Dyads_Parent Permission Form for Minor (English)_08-04-21_clean.pdf Attachment F BRANY Permission Form	IC Document
Attachment G_BRANY Approved- Parent Teen Dyad_Minor Assent Form (English)_V2_08-04-21_clean.pdf Attachment G BRANY Minor Form	IC Document
Attachment H_BRANY Approved- HHS COVID-19 Public Education Campaign_Parent Teen Dyads_How to Access Creative Testing Ads.pdf Attachment H BRANY Testing Ads	IC Document
Attachment I_IRB Approval PDF 21-074-821_SBER-Initial Review (Event ID# 185634)_20210810.pdf Attachment I BRANY IRB approval	IC Document
HHS COVID-19 Public Education Campaign_Parent Teen Dyads - Supporting Statement B.docx Supporting Statement B	IC Document
0990-0281 Generic HHS COVID-19 Public Education Campaign_Parent Teen Dyads - Supporting Statement A.docx Supporting Statement A	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

HHS COVID-19 Public Education Campaign Parent & Teen Interview Dyads

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
Other-Attachment A Guide					Yes	Yes	Fillable Fileable
Other-Attachment B Guide					Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,200	1,200
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C BRANY Screener		08/12/2021
Attachment D BRANY Screener		08/12/2021
Attachment E BRANY Consent Form		08/12/2021
Attachment F BRANY Permission Form		08/12/2021
Attachment G BRANY Minor Form		08/12/2021
Attachment H BRANY Testing Ads		08/12/2021
Attachment I BRANY IRB approval		08/12/2021
Supporting Statement B		08/12/2021
Supporting Statement A		08/12/2021

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

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