Information Collection

Message Testing: Radiation Emergencies and Cancer Risk

IC 242069 under ICR 201806-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0572 Message Testing: Radiation Emergencies and Cancer Risk	Form and Instruction
AttB Online Survey 20200602.pdf	Other-Online Screenshot
0920-0572 Message Testing Survey AttA Word Survey 20200602.docx	Form and Instruction
0 - HMTS Rqst GenIC RadiationEmrgncs CancerRisk 20200430.pdf HMTS Request Template	IC Document
AttC Protocol 20200430.docx Protocol	IC Document
AttD CDC 7275 Exempt Granted Memo 20200418.pdf IRB approval	IC Document
0 - LIst of Attachments 20200430.docx List of Attachments	IC Document

IC Title:

Message Testing: Radiation Emergencies and Cancer Risk

Agency IC Tracking Number:

0920-0572-20OV

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
Form and Instruction	0920-0572	Message Testing Survey	AttA Word Survey 20200602.docx		Yes	Yes	Fillable Fileable
Other-Online Screenshot			AttB Online Survey 20200602.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

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	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Request Template	0 - HMTS Rqst GenIC RadiationEmrgncs CancerRisk 20200430.pdf	06/02/2020
Protocol	AttC Protocol 20200430.docx	06/02/2020
IRB approval	AttD CDC 7275 Exempt Granted Memo 20200418.pdf	06/02/2020
List of Attachments	0 - LIst of Attachments 20200430.docx	06/02/2020

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