CDC and ATSDR Health Message Testing System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0572 Focus Group Discussion Guide	Form	New	Repair queued
Form 0920-0572 Focus Group Recruitment Script and Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Hand Sanitizer Interiview Guide	Form and Instruction	New	Repair queued
Form 0920-0572 Handwashing Interview Guide	Form and Instruction	New	Repair queued
Form 0920-0572 Screener	Form	New	Repair queued
Form 0920-21FM Attachment O-WRA Focus Group Discussion Guide	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment G-WRA Focus Group Screener	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment F-WRA QualBoard Discussion Board	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment F-WRA QualBoard Screener	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment E-HCP IDI Discussion Guide -RN-MA	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment E-HCP IDI Screener-RN-MA	Form and Instruction	New	Repair queued
Form 0920-21FM Attachment L-HCP QualBoard Discussion Guide	Form and Instruction	New	Repair queued
Form 092-21FM Attachment B-HCP QualBoard Screener-MD-NP-PA-MW	Form and Instruction	New	Repair queued
Form 0920-21DU In-depth Interview	Form and Instruction	New	Repair queued
Form 0920-21DU Digital Screening Form	Form and Instruction	New	Repair queued
Guide for Virtual Interview with Physicians	Form and Instruction	New	Repair queued
Guide for Virtual Interview with Nurse Practitioners or Physician Assistants	Form and Instruction	New	Repair queued
Recruitment Screener for Physicians	Form and Instruction	New	Repair queued
Recruitment Screener for Nurse Practitioners and Physician Assistants	Form and Instruction	New	Repair queued
Virtual Focus Group Guide for Consumers (Vietnamese)	Form and Instruction	New	Repair queued
Virtual Focus Group Guide for Consumers (English)	Form and Instruction	New	Repair queued
Recruitment Screener (Vietnamese)	Form and Instruction	New	Repair queued
Recruitment Screener (English)	Form and Instruction	New	Repair queued
Moderator Guides for Interviews with Healthcare Professionals	Form and Instruction	New	Repair queued
Recruitment Guide for Healthcare Professionals	Form and Instruction	New	Repair queued
Moderator Guides for Web/Telephone Focus Groups	Form and Instruction	New	Repair queued
Recruitment Guide for MSM	Form and Instruction	New	Repair queued
Form 0920-0572 Screener	Form	New	Available
Form 0920-0572 Creative Concept Testing Rating - concerned	Form	New	Available
Form 0920-0572 Creative Concept Testing Ranking Worksheet Uncon&Noncom	Form	New	Repair queued
Form 0920-0572 CDC Alcohol Creative Concept Testing Ranking Worksheet - Concerned	Form	New	Available
Form 0920-0572 CDC Alcohol - Creative Concept Testing Rating Worksheet	Form	New	Repair queued
Form 0920-0572 HCP Online Survey	Form and Instruction	New	Available
Form 0920-0572 HCP Screener Online Survey	Form and Instruction	New	Available
Form 0920-0572 HCP In Depth Interview Guide	Form and Instruction	New	Available
Form 0920-0572 HCP Screener In Depth Interview	Form and Instruction	New	Available
Form 0920-0572 PWD Online Survey	Form and Instruction	New	Available
Form 0920-0572 PWD Focus Group Moderators Guide	Form and Instruction	New	Available
Form 0920-0572 PWD Screener for Focus Groups	Form and Instruction	New	Available
Form 0920-0572 PWD Screener Online Survey	Form and Instruction	New	Available
Form 0920-20PT Consent Form_Physician	Form	New	Available
Form 0920-20PT Consent Form_Nurse-NP-PA	Form	New	Available
Form 0920-20PT Consent Form_Consumer	Form	New	Available
Form 0920-20PT Moderator Guide-FG_Consumer	Form and Instruction	New	Available
Form 0920-20PT Moderator Guide-FG_Nurse-NP-PA	Form and Instruction	New	Available
Form 0920-20PT Moderator Guide-IDI_Physician	Form and Instruction	New	Available
Form 0920-20PT Recruitment Screener_Physician	Form and Instruction	New	Repair queued
Form 0920-20PT Recruitment Screener_Nurse-NP-PA	Form and Instruction	New	Available
Form 0920-20PT Recruitment Screener_Consumer	Form and Instruction	New	Available
Form 0920-0572 Older Adult Injury Prevention Creative Campaign Survey	Form and Instruction	New	Available
Form 0920-0572 Message Testing Survey	Form and Instruction	New	Available
Form 0920-0572 Focus Group Guide Spanish	Form and Instruction	New	Available
Form 0920-0572 Focus Group Guide English	Form and Instruction	New	Available
Form 0920-0572 Focus Group Screener	Form and Instruction	New	Available
Form 0920-0572 Anthrax POD Fact Sheet	Form	New	Available
Form 0920-0572 Anthrax General Fact Sheet	Form	New	Available
Form 0920-0572 Anthrax Pregnancy Fact Sheet	Form	New	Available
Form 0920-0572 Anthrax Get Vaccinated Fact Sheet	Form	New	Available
Form 0920-0572 Anthrax Antibiotics & Children Fact Sheet	Form	New	Available
Form 0920-20MU Guide for ESL Adults	Form and Instruction	New	Available
Form 0920-20MU Guide for Parents	Form and Instruction	New	Available
Form 0920-20MU Guide for Adults 65+	Form and Instruction	New	Available
Form 0920-20MU Screening/Eligibility Form	Form and Instruction	New	Available
GAOS - Posttest - Health care providers	Form	New	Repair queued
GAOS Pretest - Health care providers	Form	New	Available
Form 0920-0572 GAOS Consumer Survey Post-test HMTS	Form and Instruction	New	Available
Form 0920-0572 GAOS Consumer Survey Pre-test HMTS	Form and Instruction	New	Available
BAA Posttest - Health care providers	Form	New	Available
BAA Pretest - Heath care providers	Form	New	Available
Form 0920-0572 BAA Consumer Survey_FINAL POSTTEST	Form and Instruction	New	Available
Form 0920-0572 BAACS Survey FINAL PRETEST	Form and Instruction	New	Available
Form 0920-0572 Focus Group Screener - Revised	Form and Instruction	New	Available
Focus Group Moderators Guide	Form and Instruction	New	Available
Screener and Focus Group Invitation	Form and Instruction	New	Available
Form 0920-0572 Crisis Next Door Questionnaire	Form and Instruction	New	Repair queued
Form 0920-0572 Crisis Next Door Screener	Form and Instruction	New	Available
Form 0920-0572 Person with DM not had DSMES Survey	Form and Instruction	New	Available
Form 0920-0572 Person with DM had DSMES Survey	Form and Instruction	New	Available
Form 0920-0572 Health Care Providers Survey	Form and Instruction	New	Available
Form 0920-0572 Diabetes Educators Survey	Form and Instruction	New	Available
Form 0920-0572 Screener People with DM	Form and Instruction	New	Repair queued
Form 0920-0572 Screener Health Care Providers	Form and Instruction	New	Available
Form 0920-0572 Screener Diabetes Educators	Form and Instruction	New	Repair queued
Form 0920-0572 Women Who Speak Spanish Screener (Eng)	Form and Instruction	New	Available
Form 0920-0572 Women Who Care for Child Screener	Form and Instruction	New	Available
Form 0920-0572 Women who Care for Aging Parent Screener	Form and Instruction	New	Available
Form 0920-0572 Sepsis Survivors Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Men Aged 65 and Older Screener	Form and Instruction	New	Available
Form 0920-0572 Caregivers to Sepsis Survivors Screener	Form and Instruction	New	Available
Form 0920-0572 Caregivers to Cancer Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Cancer Patients Screener	Form and Instruction	New	Available
Form 0920-0572 Women Who Primarily Speak Spanish Mod Guide En	Form and Instruction	New	Available
Form 0920-0572 Women Who Care for Child Mod Guide	Form and Instruction	New	Available
Form 0920-0572 Women Who Care for Aging Parent Mod Guide	Form and Instruction	New	Available
Form 0920-0572 Sepsis Survivors and Caregivers Mod Guide	Form and Instruction	New	Available
Form 0920-0572 Men Aged 65 and Older Mod Guide	Form and Instruction	New	Available
Form 0920-0572 Cancer Patients and Caregivers Mod Guide	Form and Instruction	New	Available
Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes	Form and Instruction	New	Available
Interviewer Guide for Community Pharmacists	Form and Instruction	New	Available
Interviewer Guide for Nurses in Nursing Homes	Form and Instruction	New	Available
Interviewer Guide for Hospitalists	Form and Instruction	New	Available
Interviewer Guide for Dentists	Form and Instruction	New	Available
Screening Form for Advanced Practice Providers and Physicians in Nursing Homes	Form and Instruction	New	Available
Screening Form for Community Pharmacists	Form and Instruction	New	Available
Screening Form for Nurses in Nursing Homes	Form and Instruction	New	Available
Screening Form for Hospitalists	Form and Instruction	New	Available
Screening Form for Dentists	Form and Instruction	New	Available
Screener - LTC Nurses	Form	New	Available
Screener - LTC Med tech/sitter	Form	New	Repair queued
Screener - EMS Personnel	Form	New	Available
Screener for Urgent Care adults	Form and Instruction	New	Available
Screener for SS Women - Spanish	Form and Instruction	New	Available
Screener for SS women - English	Form and Instruction	New	Available
Screener for Nursing Home Caregivers	Form and Instruction	New	Available
Screener for adults	Form and Instruction	New	Available
NMAM Customer Satisfaction Survey	Form and Instruction	New	Available
Focus Group Moderator's Guide	Form and Instruction	New	Available
Recruitment Script and Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Audience Segmentation Survey	Form and Instruction	New	Available
Form 0920-0572 Focus Group Discussion Guide	Form and Instruction	New	Available
Form 0920-0572 Focus Group Screener	Form and Instruction	New	Available
Form 0920-0572 HMTS Evaluation IDI Guide	Form and Instruction	New	Available
Form 0920-0572 HMTS Worksheet Activity	Form and Instruction	New	Repair queued
Form 0920-0572 HMTS Evaluation Consent Form	Form and Instruction	New	Available
Form 0920-0572 HMTS Evaluation Screener	Form and Instruction	New	Available
Form 0920-0572 Screening Form	Form and Instruction	New	Available
Form 0920-0572 Interview Guide	Form and Instruction	New	Available
Form 0920-0572 Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men	Form and Instruction	New	Available
Form 0920-0572 Screener - Understanding Sexual Health Messaging among Men who have Sex with Men	Form and Instruction	New	Available
Message Testing Instrument	Form and Instruction	New	Available
SS-PartB-HMTS .docx	Supporting Statement B	Uploaded 2018-06-14	Available
SS-Part A HMTS .docx	Supporting Statement A	Uploaded 2018-06-14	Available
Attachment 11 - IRB Ruling 060308.doc	Supplementary Document	Uploaded 2018-06-12	Repair queued
Attachment 10 - Examples-Data Collection Instruments 060308.doc	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 9-FollowUpQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 8-ActivityTaskQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 7-CoreQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 6-IntroductoryQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 5-MarketResearchExpQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
Attachment 4-DemographicQuestions.docx	Supplementary Document	Uploaded 2018-06-12	Available
60day FRN.pdf	Supplementary Document	Uploaded 2018-06-12	Available
Att 1-AuthLegislation.pdf	Supplementary Document	Uploaded 2018-06-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249021	A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women	Other-Password Protected file	New
249021	A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women	Form	New	Focus Group Discussion Guide
249021	A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women	Form and Instruction	New	Focus Group Recruitment Script and Screener
248270	Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults	Form and Instruction	New	Hand Sanitizer Interiview Guide
248270	Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults	Form and Instruction	New	Handwashing Interview Guide
248270	Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults	Other-English translation	New
248270	Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults	Form	New	Screener
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment O-WRA Focus Group Discussion Guide
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment G-WRA Focus Group Screener
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment F-WRA QualBoard Discussion Board
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment F-WRA QualBoard Screener
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment E-HCP IDI Discussion Guide -RN-MA
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment E-HCP IDI Screener-RN-MA
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment L-HCP QualBoard Discussion Guide
247916	Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	Form and Instruction	New	Attachment B-HCP QualBoard Screener-MD-NP-PA-MW
246515	Message Testing for Food Safety Content	Form and Instruction	New	In-depth Interview
246515	Message Testing for Food Safety Content	Form and Instruction	New	Digital Screening Form
245769	CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Guide for Virtual Interview with Physicians
245769	CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Guide for Virtual Interview with Nurse Practitioners or Physician Assistants
245769	CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Recruitment Screener for Physicians
245769	CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Recruitment Screener for Nurse Practitioners and Physician Assistants
245768	CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Virtual Focus Group Guide for Consumers (Vietnamese)
245768	CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Virtual Focus Group Guide for Consumers (English)
245768	CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Recruitment Screener (Vietnamese)
245768	CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam	Form and Instruction	New	Recruitment Screener (English)
245187	Informing Development of CDC Content about Sexually Transmitted Diseases: Interviews with Healthcare Providers	Form and Instruction	New	Moderator Guides for Interviews with Healthcare Professionals
245187	Informing Development of CDC Content about Sexually Transmitted Diseases: Interviews with Healthcare Providers	Form and Instruction	New	Recruitment Guide for Healthcare Professionals
244938	Informing Development of CDC Content about Sexually Transmitted Diseases: Focus Groups with Men Who Have Sex With Men	Form and Instruction	New	Moderator Guides for Web/Telephone Focus Groups
244938	Informing Development of CDC Content about Sexually Transmitted Diseases: Focus Groups with Men Who Have Sex With Men	Form and Instruction	New	Recruitment Guide for MSM
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Form	New	Screener
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Instruction	New
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Form	New	Creative Concept Testing Rating - concerned
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Form	New	Creative Concept Testing Ranking Worksheet Uncon&Noncom
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Form	New	CDC Alcohol Creative Concept Testing Ranking Worksheet - Concerned
242672	CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	Form	New	CDC Alcohol - Creative Concept Testing Rating Worksheet
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	HCP Online Survey
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	HCP Screener Online Survey
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	HCP In Depth Interview Guide
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	HCP Screener In Depth Interview
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	PWD Online Survey
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	PWD Focus Group Moderators Guide
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	PWD Screener for Focus Groups
242658	Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	Form and Instruction	New	PWD Screener Online Survey
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form	New	Consent Form_Physician
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form	New	Consent Form_Nurse-NP-PA
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form	New	Consent Form_Consumer
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Moderator Guide-FG_Consumer
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Moderator Guide-FG_Nurse-NP-PA
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Moderator Guide-IDI_Physician
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Recruitment Screener_Physician
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Recruitment Screener_Nurse-NP-PA
242449	Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction	New	Recruitment Screener_Consumer
242277	CDC Older Adult Injury Prevention Creative Campaign Survey	Form and Instruction	New	Older Adult Injury Prevention Creative Campaign Survey
242069	Message Testing: Radiation Emergencies and Cancer Risk	Other-Online Screenshot	New
242069	Message Testing: Radiation Emergencies and Cancer Risk	Form and Instruction	New	Message Testing Survey
241857	Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach	Form and Instruction	New	Focus Group Guide Spanish
241857	Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach	Form and Instruction	New	Focus Group Guide English
241857	Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach	Form and Instruction	New	Focus Group Screener
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form	New	Anthrax POD Fact Sheet
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form	New	Anthrax General Fact Sheet
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form	New	Anthrax Pregnancy Fact Sheet
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form	New	Anthrax Get Vaccinated Fact Sheet
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form	New	Anthrax Antibiotics & Children Fact Sheet
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form and Instruction	New	Guide for ESL Adults
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form and Instruction	New	Guide for Parents
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form and Instruction	New	Guide for Adults 65+
241417	Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	Form and Instruction	New	Screening/Eligibility Form
240040	National Firefighter Registry	Other-WORd	New
239897	Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers	Form	New	GAOS - Posttest - Health care providers
239897	Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers	Form	New	GAOS Pretest - Health care providers
239892	Assessment for the Get Ahead of Sepsis Consumer Campaign	Form and Instruction	New	GAOS Consumer Survey Post-test HMTS
239892	Assessment for the Get Ahead of Sepsis Consumer Campaign	Form and Instruction	New	GAOS Consumer Survey Pre-test HMTS
239891	Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	Form	New	BAA Posttest - Health care providers
239891	Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	Form	New	BAA Pretest - Heath care providers
239863	Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign	Form and Instruction	New	BAA Consumer Survey_FINAL POSTTEST
239863	Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign	Form and Instruction	New	BAACS Survey FINAL PRETEST
239722	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener	Form and Instruction	New	Focus Group Screener - Revised
238568	Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults	Form and Instruction	New	Focus Group Moderators Guide
238568	Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults	Form and Instruction	New	Screener and Focus Group Invitation
238053	Crisis Next Door Campaign Assessment	Form and Instruction	New	Crisis Next Door Questionnaire
238053	Crisis Next Door Campaign Assessment	Form and Instruction	New	Crisis Next Door Screener
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Person with DM not had DSMES Survey
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Person with DM had DSMES Survey
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Health Care Providers Survey
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Diabetes Educators Survey
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Screener People with DM
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Screener Health Care Providers
238018	Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	Form and Instruction	New	Screener Diabetes Educators
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women Who Speak Spanish Screener (Eng)
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women Who Care for Child Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women who Care for Aging Parent Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Sepsis Survivors Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Men Aged 65 and Older Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Caregivers to Sepsis Survivors Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Caregivers to Cancer Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Cancer Patients Screener
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women Who Primarily Speak Spanish Mod Guide En
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women Who Care for Child Mod Guide
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Women Who Care for Aging Parent Mod Guide
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Sepsis Survivors and Caregivers Mod Guide
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Men Aged 65 and Older Mod Guide
237889	Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	Form and Instruction	New	Cancer Patients and Caregivers Mod Guide
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Interviewer Guide for Community Pharmacists
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Interviewer Guide for Nurses in Nursing Homes
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Interviewer Guide for Hospitalists
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Interviewer Guide for Dentists
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Screening Form for Advanced Practice Providers and Physicians in Nursing Homes
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Screening Form for Community Pharmacists
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Screening Form for Nurses in Nursing Homes
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Screening Form for Hospitalists
237853	Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	Form and Instruction	New	Screening Form for Dentists
237852	Get Ahead of Sepsis for Healthcare Providers	Other-Moderator Guide	New
237852	Get Ahead of Sepsis for Healthcare Providers	Form	New	Screener - LTC Nurses
237852	Get Ahead of Sepsis for Healthcare Providers	Form	New	Screener - LTC Med tech/sitter
237852	Get Ahead of Sepsis for Healthcare Providers	Form	New	Screener - EMS Personnel
237741	Be Antibiotic Aware Campaign	Form and Instruction	New	Screener for Urgent Care adults
237741	Be Antibiotic Aware Campaign	Form and Instruction	New	Screener for SS Women - Spanish
237741	Be Antibiotic Aware Campaign	Form and Instruction	New	Screener for SS women - English
237741	Be Antibiotic Aware Campaign	Form and Instruction	New	Screener for Nursing Home Caregivers
237741	Be Antibiotic Aware Campaign	Form and Instruction	New	Screener for adults
237741	Be Antibiotic Aware Campaign	Other-Focus group guide	New
237688	NIOSH Manual of Analytical Methods Survey	Form and Instruction	New	NMAM Customer Satisfaction Survey
237042	A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	Form and Instruction	New	Focus Group Moderator's Guide
237042	A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	Form and Instruction	New	Recruitment Script and Screener
236245	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing	Form and Instruction	New	Audience Segmentation Survey
236245	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing	Form and Instruction	New	Focus Group Discussion Guide
236245	Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing	Form and Instruction	New	Focus Group Screener
234826	Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	Form and Instruction	New	HMTS Evaluation IDI Guide
234826	Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	Form and Instruction	New	HMTS Worksheet Activity
234826	Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	Form and Instruction	New	HMTS Evaluation Consent Form
234826	Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	Form and Instruction	New	HMTS Evaluation Screener
234749	Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults	Form and Instruction	New	Screening Form
234749	Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults	Form and Instruction	New	Interview Guide
233703	Sexual Health Study for Gay and Bisexual Men	Form and Instruction	New	Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men
233703	Sexual Health Study for Gay and Bisexual Men	Form and Instruction	New	Screener - Understanding Sexual Health Messaging among Men who have Sex with Men
232694	Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak	Form and Instruction	New	Message Testing Instrument

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 201806-0920-001
Status: Historical Active	Previous ICR Reference No: 201502-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0572
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/11/2018
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved
Responses	55,575	0	0
Time Burden (Hours)	7,410	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC must communicate about hazards, outbreaks and other emergencies that present an urgent health threat to the public. Untested messages can waste communication resources and opportunities because the messages can be perceived as unclear or irrelevant. OADC-CDC requests a reinstatement without change for the generic clearance for an expedited review of items to be used in health message testing to ensure the public will understand health messages and take recommended action.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 21776	05/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 32124	07/11/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 35

table that charts list of burden

IC Title	Form No.	Form Name
A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women	0920-0572, 0920-0572	Focus Group Recruitment Script and Screener ,   Focus Group Discussion Guide
A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	n/a, n/a	Recruitment Script and Screener ,   Focus Group Moderator's Guide
Assessment for the Be Antibiotics Aware (BAA) Consumer Campaign	0920-0572, 0920-0572	BAACS Survey FINAL PRETEST ,   BAA Consumer Survey_FINAL POSTTEST
Assessment for the Be Antibiotics Aware Campaign - Health Care Providers	none, none	BAA Pretest - Heath care providers ,   BAA Posttest - Health care providers
Assessment for the Get Ahead of Sepsis Consumer Campaign	0920-0572, 0920-0572	GAOS Consumer Survey Pre-test HMTS ,   GAOS Consumer Survey Post-test HMTS
Assessment of Get Ahead of Sepsis Camplaign - Health Care Providers	none, none	GAOS Pretest - Health care providers ,   GAOS - Posttest - Health care providers
Be Antibiotic Aware Campaign	none, none, none, none, none	Screener for adults ,   Screener for Nursing Home Caregivers ,   Screener for SS women - English ,   Screener for SS Women - Spanish ,   Screener for Urgent Care adults
Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	PWD Screener for Focus Groups ,   PWD Focus Group Moderators Guide ,   PWD Screener Online Survey ,   PWD Online Survey ,   HCP Screener In Depth Interview ,   HCP In Depth Interview Guide ,   HCP Screener Online Survey ,   HCP Online Survey
CDC Enhanced Message Development and Testing to Prevent Excessive Alcohol Consumption Study – Creative Concept Testing Focus Groups/Copy Testing Survey	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	CDC Alcohol - Creative Concept Testing Rating Worksheet ,   CDC Alcohol Creative Concept Testing Ranking Worksheet - Concerned ,   Creative Concept Testing Ranking Worksheet Uncon&Noncom ,   Creative Concept Testing Rating - concerned ,   Screener
CDC Latent Tuberculosis Infection Campaign: Message Testing with Consumers Born in The Philippines and Vietnam	n/a, n/a, n/a, n/a	Recruitment Screener (English) ,   Recruitment Screener (Vietnamese) ,   Virtual Focus Group Guide for Consumers (English) ,   Virtual Focus Group Guide for Consumers (Vietnamese)
CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam	n/a, n/a, n/a, n/a	Recruitment Screener for Nurse Practitioners and Physician Assistants ,   Recruitment Screener for Physicians ,   Guide for Virtual Interview with Nurse Practitioners or Physician Assistants ,   Guide for Virtual Interview with Physicians
CDC Older Adult Injury Prevention Creative Campaign Survey	0920-0572	Older Adult Injury Prevention Creative Campaign Survey
Communication Emphasizing Consequences, Protective Actions and Target Populations in an Infectious Disease Outbreak	none	Message Testing Instrument
Communication Support for the National Center for Emerging and Zoonotic Infectious Diseases; Anthrax Materials Testing	0920-20MU, 0920-20MU, 0920-20MU, 0920-20MU, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screening/Eligibility Form ,   Guide for Adults 65+ ,   Guide for Parents ,   Guide for ESL Adults ,   Anthrax Antibiotics & Children Fact Sheet ,   Anthrax Get Vaccinated Fact Sheet ,   Anthrax Pregnancy Fact Sheet ,   Anthrax General Fact Sheet ,   Anthrax POD Fact Sheet
Crisis Next Door Campaign Assessment	0920-0572, 0920-0572	Crisis Next Door Screener ,   Crisis Next Door Questionnaire
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing	0920-0572, 0920-0572, 0920-0572	Focus Group Screener ,   Focus Group Discussion Guide ,   Audience Segmentation Survey
Developing Effective Messages about Excessive Alcohol Consumption: Enhanced Message Development and Testing - Revised Screener	0920-0572	Focus Group Screener - Revised
Evaluation of Emergency Use Fact Sheets Regarding Medical Countermeasures – Comprehension	0920-0572, 0920-0572, 0920-0572, 0920-0572	HMTS Evaluation Screener ,   HMTS Evaluation Consent Form ,   HMTS Worksheet Activity ,   HMTS Evaluation IDI Guide
Get Ahead of Sepsis for Healthcare Providers	none, none, none	Screener - EMS Personnel ,   Screener - LTC Med tech/sitter ,   Screener - LTC Nurses
Health Communications Testing for Latent Tuberculosis Infections Campaign	0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT, 0920-20PT	Recruitment Screener_Consumer ,   Recruitment Screener_Nurse-NP-PA ,   Recruitment Screener_Physician ,   Moderator Guide-IDI_Physician ,   Moderator Guide-FG_Nurse-NP-PA ,   Moderator Guide-FG_Consumer ,   Consent Form_Consumer ,   Consent Form_Nurse-NP-PA ,   Consent Form_Physician
Informing Development of CDC Content about Sexually Transmitted Diseases: Focus Groups with Men Who Have Sex With Men	n/a, n/a	Recruitment Guide for MSM ,   Moderator Guides for Web/Telephone Focus Groups
Informing Development of CDC Content about Sexually Transmitted Diseases: Interviews with Healthcare Providers	n/a, n/a	Recruitment Guide for Healthcare Professionals ,   Moderator Guides for Interviews with Healthcare Professionals
Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screener Diabetes Educators ,   Screener Health Care Providers ,   Screener People with DM ,   Diabetes Educators Survey ,   Health Care Providers Survey ,   Person with DM had DSMES Survey ,   Person with DM not had DSMES Survey
Message Testing for Food Safety Content	0920-21DU, 0920-21DU	Digital Screening Form ,   In-depth Interview
Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy	0920-21FM, 092-21FM, 0920-21FM, 0920-21FM, 0920-21FM, 0920-21FM, 0920-21FM, 0920-21FM	Attachment B-HCP QualBoard Screener-MD-NP-PA-MW ,   Attachment L-HCP QualBoard Discussion Guide ,   Attachment E-HCP IDI Screener-RN-MA ,   Attachment E-HCP IDI Discussion Guide -RN-MA ,   Attachment F-WRA QualBoard Screener ,   Attachment F-WRA QualBoard Discussion Board ,   Attachment G-WRA Focus Group Screener ,   Attachment O-WRA Focus Group Discussion Guide
Message Testing: Radiation Emergencies and Cancer Risk	0920-0572	Message Testing Survey
Message and Material Testing for the Get Ahead of Sepsis (GAOS) Campaign for Consumer Audiences	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Cancer Patients and Caregivers Mod Guide ,   Men Aged 65 and Older Mod Guide ,   Sepsis Survivors and Caregivers Mod Guide ,   Women Who Care for Aging Parent Mod Guide ,   Women Who Care for Child Mod Guide ,   Women Who Primarily Speak Spanish Mod Guide En ,   Cancer Patients Screener ,   Caregivers to Cancer Screener ,   Caregivers to Sepsis Survivors Screener ,   Men Aged 65 and Older Screener ,   Sepsis Survivors Screener ,   Women who Care for Aging Parent Screener ,   Women Who Care for Child Screener ,   Women Who Speak Spanish Screener (Eng)
Message and material testing for the Be Antibiotics Aware (BAA) campaign for healthcare providers (HCPs)	n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a, n/a	Screening Form for Dentists ,   Screening Form for Hospitalists ,   Screening Form for Nurses in Nursing Homes ,   Screening Form for Community Pharmacists ,   Screening Form for Advanced Practice Providers and Physicians in Nursing Homes ,   Interviewer Guide for Dentists ,   Interviewer Guide for Hospitalists ,   Interviewer Guide for Nurses in Nursing Homes ,   Interviewer Guide for Community Pharmacists ,   Interviewer Guide for Advanced Practice Providers and Physicians in Nursing Homes
NIOSH Manual of Analytical Methods Survey	n/a	NMAM Customer Satisfaction Survey
National Firefighter Registry
Parents' Knowledge, Skills, Attitudes & Beliefs regarding Children's Bullying: A Research to Practice Approach	0920-0572, 0920-0572, 0920-0572	Focus Group Screener ,   Focus Group Guide English ,   Focus Group Guide Spanish
Sexual Health Study for Gay and Bisexual Men	0920-0572, 0920-0572	Screener - Understanding Sexual Health Messaging among Men who have Sex with Men ,   Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men
Testing Handwashing and Hand Sanitizer Practices Among Spanish-speaking Adults	0920-0572, 0920-0572, 0920-0572	Screener ,   Handwashing Interview Guide ,   Hand Sanitizer Interiview Guide
Testing Health Communication Messages to Promote Hand Hygiene Behavior Among U.S. Adults	0920-0572, 0920-0572	Interview Guide ,   Screening Form
Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults	n/a, n/a	Screener and Focus Group Invitation ,   Focus Group Moderators Guide

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,575	0	0	0	0	55,575
Annual Time Burden (Hours)	7,410	0	0	0	0	7,410
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,550,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/11/2018

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