Message Testing: Radiation Emergencies and Cancer Risk

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.