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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.