A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death Form and Instruction
Recruitment Script and Screener Attachment 2_Focus Group Recruitment Script and Screener_19Jul2019.docx Form and Instruction
Focus Group Moderator's Guide Attachment 3_Focus Group Moderator Guide_19July2019.docx Form and Instruction
HMTS~WN4.PDF HMTS Template with Project Overview IC Document
Attachment 1_Background Information_19Jul2019.docx Additional Project Background and Description IC Document
Attachment 4_Consent Form for Focus Group Participation_19Jul2019.docx Focus Group Consent Form IC Document
Attachment 5_Notification Scripts_19July019.docx Script for Notifying Respondents of Eligibility IC Document
Attachment 6_Recruitment Flyer_19July2019.docx Recruitment Flyer IC Document
Attachment 7_Creative Concepts_July 2019.pptx Creative Concepts to be Tested IC Document

Information Collection (IC) Details

IC Title:	A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	Agency IC Tracking Number:	0920-19BLV

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 and Instruction	n/a	Recruitment Script and Screener	Attachment 2_Focus Group Recruitment Script and Screener_19Jul2019.docx		No		Paper Only
Form and Instruction	n/a	Focus Group Moderator's Guide	Attachment 3_Focus Group Moderator Guide_19July2019.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	245	245
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HMTS Template with Project Overview	HMTS~WN4.PDF	07/22/2019
Additional Project Background and Description	Attachment 1_Background Information_19Jul2019.docx	07/22/2019
Focus Group Consent Form	Attachment 4_Consent Form for Focus Group Participation_19Jul2019.docx	07/22/2019
Script for Notifying Respondents of Eligibility	Attachment 5_Notification Scripts_19July019.docx	07/22/2019
Recruitment Flyer	Attachment 6_Recruitment Flyer_19July2019.docx	07/22/2019
Creative Concepts to be Tested	Attachment 7_Creative Concepts_July 2019.pptx	07/22/2019

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