Information Collection

CDC Older Adult Injury Prevention Creative Campaign Survey

IC 242277 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⚠️ Notice: This information collection may be referencing outdated material.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 Older Adult Injury Prevention Creative Campaign Survey CDC Older Adult Injury Prevention Creative Campaign Survey	Form and Instruction
0920-0572 Older Adult Injury Prevention Creative Campaign Survey Att 1a_CDC Older Adult Injury Prevention Creative Campaign Survey Screenshots_5.11.20.docx	Form and Instruction
Att 2_Project Description_CDC Older Adult Injury Prevention Creative Campaign_5.11.20.docx Project Description	IC Document
PIA Email.pdf PIA Memo	IC Document
Att 1a_CDC Older Adult Injury Prevention Creative Campaign Survey Screenshots_5.11.20.docx Mesages to be Tested - CDC Older Adult Injury Prevention Creative Campaign	IC Document
HMTSExpeditedReviewForm_CDC Older adult injury prevention creative Campaign survey.pdf HMTS Expedited Review Form	IC Document

IC Title:

CDC Older Adult Injury Prevention Creative Campaign Survey

Agency IC Tracking Number:

0920-0572-20PL

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	Older Adult Injury Prevention Creative Campaign Survey	Att 1a_CDC Older Adult Injury Prevention Creative Campaign Survey Screenshots_5.11.20.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Project Description	Att 2_Project Description_CDC Older Adult Injury Prevention Creative Campaign_5.11.20.docx	06/18/2020
PIA Memo	PIA Email.pdf	06/18/2020
Mesages to be Tested - CDC Older Adult Injury Prevention Creative Campaign	Att 1a_CDC Older Adult Injury Prevention Creative Campaign Survey Screenshots_5.11.20.docx	06/18/2020
HMTS Expedited Review Form	HMTSExpeditedReviewForm_CDC Older adult injury prevention creative Campaign survey.pdf	06/18/2020

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