Information Collection

Constituent Feedback to Oral Health Education Messages and Materials

IC 244935 under ICR 202012-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1-1 RS Constituent Feedback to Oral Health Education Messages and Materials	Form
1-1 RS attachment 1 - focus group participant recruitment scree attachment 1 - focus group participant recruitment screener.docx	Form
1-2 RS attachment 2 - cognitive interview participant recruitme attachment 2 - cognitive interview participant recruitment screener.docx	Form
1-3 RS attachment 3 - online discussion board participant recru attachment 3 - online discussion board participant recruitment screener.docx	Form
2-1 EP attachment 4 - focus group evaluation protocols.docx attachment 4 - focus group evaluation protocols.docx	Form
2-2 EP attachment 5 - cognitive interview evaluation protocols. attachment 5 - cognitive interview evaluation protocols.docx	Form
2-3 EP attachment 6 - online discussion board evaluation protoc attachment 6 - online discussion board evaluation protocols.docx	Form
FINALsupporting statement a.docx Supporting Statement A	IC Document
attachment 7 - brushing and flossing brochure.pdf attachment 7 - brushing and flossing brochure	IC Document
attachment 8 - dry mouth brochure.pdf attachment 8 - dry mouth brochure	IC Document
attachment 9 - oral cancer brochure.pdf attachment 9 - oral cancer brochure	IC Document
attachment 10 - baby's oral health brochure.pdf attachment 10 - baby's oral health brochure	IC Document
attachment 11 - brushing child's teeth brochure.pdf attachment 11 - brushing child's teeth brochure	IC Document
attachment 12 - oral health and HIV brochure.pdf attachment 12 - oral health and HIV brochure	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Constituent Feedback to Oral Health Education Messages and Materials

Agency IC Tracking Number:

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
Form	1-1 RS	attachment 1 - focus group participant recruitment screener.docx	attachment 1 - focus group participant recruitment screener.docx	Yes	Yes	Fillable Fileable
Form	1-2 RS	attachment 2 - cognitive interview participant recruitment screener.docx	attachment 2 - cognitive interview participant recruitment screener.docx	Yes	Yes	Fillable Fileable
Form	1-3 RS	attachment 3 - online discussion board participant recruitment screener.docx	attachment 3 - online discussion board participant recruitment screener.docx	Yes	Yes	Fillable Fileable
Form	2-1 EP	attachment 4 - focus group evaluation protocols.docx	attachment 4 - focus group evaluation protocols.docx	Yes	Yes	Fillable Fileable
Form	2-2 EP	attachment 5 - cognitive interview evaluation protocols.docx	attachment 5 - cognitive interview evaluation protocols.docx	Yes	Yes	Fillable Fileable
Form	2-3 EP	attachment 6 - online discussion board evaluation protocols.docx	attachment 6 - online discussion board evaluation protocols.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 308

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	308	308
Annual IC Time Burden (Hours)	182	182
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	FINALsupporting statement a.docx	12/15/2020
attachment 7 - brushing and flossing brochure	attachment 7 - brushing and flossing brochure.pdf	12/15/2020
attachment 8 - dry mouth brochure	attachment 8 - dry mouth brochure.pdf	12/15/2020
attachment 9 - oral cancer brochure	attachment 9 - oral cancer brochure.pdf	12/15/2020
attachment 10 - baby's oral health brochure	attachment 10 - baby's oral health brochure.pdf	12/15/2020
attachment 11 - brushing child's teeth brochure	attachment 11 - brushing child's teeth brochure.pdf	12/15/2020
attachment 12 - oral health and HIV brochure	attachment 12 - oral health and HIV brochure.pdf	12/15/2020

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