Information Collection

Health Communication Message Testing on Adolescent Health

IC 235234 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
Att 2a_Moderator's Guides.docx Other-Moderator Guide
Recruitment Screener Att 2b_Screener - Parent-Caregiver Recruitment.docx Form and Instruction
Professional Outreach Email and Screener Att 2c_Professional Outreach Emails and Screening Questions.docx Form and Instruction
Att 3a_Email-No IRB Needed.pdf IRB Approval IC Document
Att 3b_Project Determination and Approval Form.pdf Non-research determination IC Document
Att 4_Themes, Terms, and Messages.docx Themes and Terms IC Document
Att 5_ Fact Sheet.pdf DASH Fact Sheet IC Document
Att 6_Study Protocol.docx Study Protocol IC Document
SSB_DASH.docx Supporting Statement B IC Document
SSA_DASH_03.07.19_rev.docx Supporting Statement A IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Communication Message Testing on Adolescent Health	Agency IC Tracking Number:	0920-0840-19ACE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Moderator Guide			Att 2a_Moderator's Guides.docx	Yes	No	Paper Only
Form and Instruction	none	Recruitment Screener	Att 2b_Screener - Parent-Caregiver Recruitment.docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	Professional Outreach Email and Screener	Att 2c_Professional Outreach Emails and Screening Questions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,698	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	2,698	2,698
Annual IC Time Burden (Hours)	535	535
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IRB Approval	Att 3a_Email-No IRB Needed.pdf	03/07/2019
Non-research determination	Att 3b_Project Determination and Approval Form.pdf	03/07/2019
Themes and Terms	Att 4_Themes, Terms, and Messages.docx	03/07/2019
DASH Fact Sheet	Att 5_ Fact Sheet.pdf	03/07/2019
Study Protocol	Att 6_Study Protocol.docx	03/07/2019
Supporting Statement B	SSB_DASH.docx	03/07/2019
Supporting Statement A	SSA_DASH_03.07.19_rev.docx	03/11/2019

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