CDC Older Adult Injury Prevention Creative Campaign Survey

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.