CDC and ATSDR Health Message Testing System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0572 Questionnaire-Spanish_online	Form and Instruction	New	Repair queued
Form 0920-0572 Questionnaire-Spanish_paper	Form and Instruction	New	Repair queued
Form 0920-0572 Questionnaire-English_online	Form and Instruction	New	Repair queued
Form 0920-0572 Questionnaire-English_paper	Form and Instruction	New	Repair queued
Form 0920-0572 Informed Consent - Spanish	Form and Instruction	New	Repair queued
Form 0920--0572 Informed Consent - English	Form and Instruction	New	Repair queued
Form 0920-0572 Screener - Spanish_online	Form and Instruction	New	Repair queued
Form 0920-0572 Screener - Spanish_paper	Form and Instruction	New	Repair queued
Form 0920-0572 Screener - English_online	Form and Instruction	New	Repair queued
Form 0920-0572 Screener - English_paper	Form and Instruction	New	Repair queued
Form 0920-0572 Recruitment Language - Spanish	Form and Instruction	New	Repair queued
Form 0920-0572 Recruitment Language - English	Form and Instruction	New	Repair queued
Form 0920-0572 ADCES Exhibit Hall Playbook Survey	Form	New	Repair queued
Form 0920-0572 Programmed Message Test Online Version (24GY)	Form and Instruction	New	Repair queued
Form 0920-0572 CDC Inside Knowledge Message Testing	Form and Instruction	New	Repair queued
Form 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Small Group Discussion Guide (24FF)	Form and Instruction	New	Repair queued
Form 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Interview Guide (24FF)	Form and Instruction	New	Repair queued
Form 0920-0572 Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Screener (24FF)	Form and Instruction	New	Repair queued
Infant Feeding Moderators Guide	Form and Instruction	New	Repair queued
Infant Feeding Screening Instrument	Form and Instruction	New	Repair queued
Form 0920-0572 Qualitative Focus Group Discussion Guide – All Audiences	Form	New	Repair queued
Form 0920-0572 Public Health Professionals Quantitative Testing Instrument	Form and Instruction	New	Repair queued
Form 0920-0572 General Population Quantitative Testing Instrument	Form and Instruction	New	Repair queued
Form 0920-0572 Screening Questionnaire	Form and Instruction	New	Repair queued
Form 0920-0572 General Population Screening Questionnaire	Form	New	Repair queued
Form 0920-0572 Tribal Survey (24CQ) Edited	Form	New	Repair queued
Form 0920-0572 Baseline Survey (24CQ) Edited	Form and Instruction	New	Repair queued
Form 0920-0572 Tribal Survey (24CQ)	Form	New	Repair queued
Form 0920-0572 Follow-Up Survey (24CQ)	Form	New	Repair queued
Form 0920-0572 Weekly Surveys Control Group (24CQ)	Form	New	Repair queued
Form 0920-0572 Weekly Surveys Treatment Group (24CQ)	Form	New	Repair queued
Form 0920-0572 Baseline Survey (24CQ)	Form and Instruction	New	Repair queued
Form 0920-0572 Consent Form Tribal Sample (24CQ)	Form and Instruction	New	Repair queued
Form 0920-0572 Consent Form Main Sample (24CQ)	Form and Instruction	New	Repair queued
Form 0920-20572 Screener (24CQ)	Form	New	Repair queued
Tribal Elders Survey	Form and Instruction	New	Repair queued
General Older Adults Survey	Form and Instruction	New	Repair queued
Survey Invitation	Form and Instruction	New	Repair queued
Form 0920-23HZ Screening/Interview Guide	Form and Instruction	New	Repair queued
Form 0920-23HZ Interview Guide	Form and Instruction	New	Repair queued
Form 0920-0572 Survey for Infant and Toddler Nutrition Ads	Form and Instruction	New	Repair queued
Form 0920-0572 Survey for Sugary Drinks Ads	Form and Instruction	New	Repair queued
Form 0920-0572 Survey for Physical Activity Ads	Form and Instruction	New	Repair queued
Form 0920-0572 Screener for Infant and Toddler Nutrition Ads Survey	Form and Instruction	New	Repair queued
Form 0920-0572 Screener for Sugary Drinks Ads Survey	Form and Instruction	New	Repair queued
Form 0920-0572 Screener for Physical Activity Ads Survey	Form and Instruction	New	Repair queued
Form 0920-23DS Attachment 4_Focus Group Consent Form_FINAL	Form	New	Repair queued
Form 0920-23DS Attachment 8_Online Panel Survey_FINAL (002)	Form	New	Repair queued
Form 0920-23CH Attachment C_FGD screener	Form and Instruction	New	Repair queued
Form 0920-22JE Attachment C. Health Provider Focus Group Participant Screener	Form and Instruction	New	Repair queued
Form 0920-22JE Attachment B. Consumer Focus Group Participant Screener	Form	New	Repair queued
Form 0920-22IZ Discussion Guide	Form and Instruction	New	Repair queued
Form 0920-22IZ Screener	Form and Instruction	New	Repair queued
Form 0920-22IO Att. 1_ DM FGD recruitment & Screening form	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Discussion Guide - Spanlish	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Discussion Guide - English	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Consent - Spanish	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Consent - English	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Screener - Spanish	Form and Instruction	New	Repair queued
Form 0920-0572 Screen For Life Focus Group Screener - English	Form and Instruction	New	Repair queued
Form 0920-0572 Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Survey	Form and Instruction	New	Repair queued
Form 0920-22FW Attachment 6. Appendix E. HCP Survey Instrument for Unexposed	Form and Instruction	New	Repair queued
Form 0920-22FW Attachment 5. Appendix D. HCP Survey Instrument for Exposed	Form and Instruction	New	Repair queued
Form 0920-22FW Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed	Form and Instruction	New	Repair queued
Form 0920-22FW Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed	Form and Instruction	New	Repair queued
Form 0920-22FQ B.DSTDP_sexual comms young adults_Informed consent_Screener_Questionnaire	Form and Instruction	New	Repair queued
Form 0920-22EZ Focus Group Discussion	Form and Instruction	New	Repair queued
Form 0920-22EZ Recruitment Screener	Form and Instruction	New	Repair queued
Form 0920-0572 Focus Groups: Communication Materials	Form and Instruction	New	Repair queued
Form 0920-0572 In-Depth Interviews: Communication Materials	Form and Instruction	New	Repair queued
Form 0920-22EC Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002)	Form and Instruction	New	Repair queued
Focus Group Discussion Guide	Form and Instruction	New	Repair queued
Form 0920-22DZ Attachment G. Enrollment Log	Form	New	Repair queued
Form 0920-22DZ Attachment E. Survey Consent	Form	New	Repair queued
Form 0920-22DZ Attachment D. Screener and Survey	Form and Instruction	New	Repair queued
Form 0920-0572 B2 Client Screener	Form	New	Repair queued
Form 0920-0572 B1 Client Screener	Form	New	Repair queued
Form 0920-0572 B2 Client Recruitment Script	Form	New	Repair queued
Form 0920-0572 B1 Client Recruitment Script	Form	New	Repair queued
Form 0920-0572 In-depth Interview Guide	Form	New	Repair queued
Form 0920-0572 Clinic Staff In-depth Interview Consent Script	Form	New	Repair queued
Form 0920-0572 B2 Applicant Consent Script (Child's Blood Test)	Form	New	Repair queued
Form 0920-0572 B1 Applicant Consent Script (Chest X-Ray)	Form	New	Repair queued
Form 0920-0572 B1 Applicant Intercept Interview Guide	Form	New	Repair queued
Form 0920-0572 B2 Moving to the United States and Your Health	Form	New	Repair queued
Form 0920-0572 B1 Your Health and Moving to the United States	Form	New	Repair queued
Form 0920-0572 Educational Video (script)	Form	New	Repair queued
Form 0920-0572 Focus Group Discussion Guide	Form and Instruction	New	Available
Form 0920-0572 Focus Group Invitation	Form and Instruction	New	Available
Form 0920-0572 Focus Group Screening Form	Form and Instruction	New	Available
Attachment 3 - Health Message Testing System Expedited Review Form .docx	Supplementary Document	Uploaded 2021-08-30	Repair queued
60dy210572 0052.docx	Supplementary Document	Uploaded 2021-08-30	Repair queued
Attachment 4-DemographicQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 5-MarketResearchExpQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 6-IntroductoryQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 7-CoreQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 8-ActivityTaskQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 9-FollowUpQuestions.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 10 - Examples-Data Collection Instruments 060308.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
Att 1-AuthLegislation.pdf	Supplementary Document	Uploaded 2021-08-05	Repair queued
Attachment 11 - IRB Ruling 060308.docx	Supplementary Document	Uploaded 2021-08-05	Repair queued
SS-PartB-HMTS .docx	Supporting Statement B	Uploaded 2021-08-30	Repair queued
SS-Part A HMTS .docx	Supporting Statement A	Uploaded 2021-08-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Questionnaire-Spanish_online
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Questionnaire-Spanish_paper
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Questionnaire-English_online
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Questionnaire-English_paper
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Informed Consent - Spanish
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Informed Consent - English
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Screener - Spanish_online
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Screener - Spanish_paper
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Screener - English_online
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Screener - English_paper
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Recruitment Language - Spanish
270598	[OC] DCPC Screen for Life	Form and Instruction	New	Recruitment Language - English
269901	[OADC] DSMES Playbook Survey at ADCES Exhibit Hall	Form	New	ADCES Exhibit Hall Playbook Survey
269901	[OADC] DSMES Playbook Survey at ADCES Exhibit Hall	Other-WORD version	New
269034	[OADC] Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Material Testing	Form and Instruction	New	Programmed Message Test Online Version (24GY)
269034	[OADC] Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Material Testing	Form and Instruction	New	CDC Inside Knowledge Message Testing
269034	[OADC] Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Material Testing	Other-WORD version	New
267348	[OADC] Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing	Form and Instruction	New	Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Small Group Discussion Guide (24FF)
267348	[OADC] Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing	Form and Instruction	New	Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Interview Guide (24FF)
267348	[OADC] Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing	Form and Instruction	New	Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Screener (24FF)
267238	[OADC] Infant Feeding Message Testing in Radiation Emergencies	Form and Instruction	New	Infant Feeding Moderators Guide
267238	[OADC] Infant Feeding Message Testing in Radiation Emergencies	Form and Instruction	New	Infant Feeding Screening Instrument
267238	[OADC] Infant Feeding Message Testing in Radiation Emergencies	Other-Info Sheet	New
265660	[OADC] Developing and Testing New Infographics for Health Equity	Form	New	Qualitative Focus Group Discussion Guide – All Audiences
265660	[OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction	New	Public Health Professionals Quantitative Testing Instrument
265660	[OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction	New	General Population Quantitative Testing Instrument
265660	[OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction	New	Screening Questionnaire
265660	[OADC] Developing and Testing New Infographics for Health Equity	Form	New	General Population Screening Questionnaire
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Tribal Survey (24CQ) Edited
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form and Instruction	New	Baseline Survey (24CQ) Edited
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Tribal Survey (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Follow-Up Survey (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Weekly Surveys Control Group (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Weekly Surveys Treatment Group (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form and Instruction	New	Baseline Survey (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form and Instruction	New	Consent Form Tribal Sample (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form and Instruction	New	Consent Form Main Sample (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Form	New	Screener (24CQ)
264966	[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	Instruction	New
262195	[OADC] Still Going Strong Campaign Expansion Pilot Testing Survey	Form and Instruction	New	Tribal Elders Survey
262195	[OADC] Still Going Strong Campaign Expansion Pilot Testing Survey	Form and Instruction	New	General Older Adults Survey
262195	[OADC] Still Going Strong Campaign Expansion Pilot Testing Survey	Form and Instruction	New	Survey Invitation
262068	[OADC] In Depth Interviews with Obstetric Nurses and Obstetric Nurse Practitioners to Test Hear Her Campaign Materials	Form and Instruction	New	Screening/Interview Guide
262068	[OADC] In Depth Interviews with Obstetric Nurses and Obstetric Nurse Practitioners to Test Hear Her Campaign Materials	Form and Instruction	New	Interview Guide
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Survey for Infant and Toddler Nutrition Ads
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Survey for Sugary Drinks Ads
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Survey for Physical Activity Ads
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Screener for Infant and Toddler Nutrition Ads Survey
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Screener for Sugary Drinks Ads Survey
261449	[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction	New	Screener for Physical Activity Ads Survey
259299	[OADC] Formative Evaluation to Assess the Effectiveness of Excessive Alcohol Use Prevention Messages - Public Health Stakeholder Focus Groups	Form	New	Attachment 4_Focus Group Consent Form_FINAL
259299	[OADC] Formative Evaluation to Assess the Effectiveness of Excessive Alcohol Use Prevention Messages - Public Health Stakeholder Focus Groups	Form	New	Attachment 8_Online Panel Survey_FINAL (002)
258024	[OADC] HEADS UP! Parents Messaging Concussion Care Message Materials Testing	Form and Instruction	New	Attachment C_FGD screener
257420	[OADC] One Health Office Healthy Pets, Healthy People Message Testing	Other-WORD	New
256272	Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Formative Focus Group Research	Form and Instruction	New	Attachment C. Health Provider Focus Group Participant Screener
256272	Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Formative Focus Group Research	Form	New	Attachment B. Consumer Focus Group Participant Screener
256147	DNPAO Message and Materials Testing	Form and Instruction	New	Discussion Guide
256147	DNPAO Message and Materials Testing	Form and Instruction	New	Screener
255678	Dating Matters - Rebranding	Form and Instruction	New	Att. 1_ DM FGD recruitment & Screening form
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Discussion Guide - Spanlish
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Discussion Guide - English
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Consent - Spanish
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Consent - English
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Screener - Spanish
254285	CDC Screen for Life Pretesting Focus Groups	Form and Instruction	New	Screen For Life Focus Group Screener - English
254176	Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs)	Form and Instruction	New	Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Screener
254176	Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs)	Form and Instruction	New	Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Survey
254038	Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign	Form and Instruction	New	Attachment 6. Appendix E. HCP Survey Instrument for Unexposed
254038	Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign	Form and Instruction	New	Attachment 5. Appendix D. HCP Survey Instrument for Exposed
254038	Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign	Form and Instruction	New	Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed
254038	Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign	Form and Instruction	New	Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed
253949	Sexual health communication among young adults.	Form and Instruction	New	B.DSTDP_sexual comms young adults_Informed consent_Screener_Questionnaire
253114	Message and Materials Testing to Expand Essentials for Parenting	Form and Instruction	New	Focus Group Discussion
253114	Message and Materials Testing to Expand Essentials for Parenting	Form and Instruction	New	Recruitment Screener
252904	Health Equity Message Testing	Form and Instruction	New	Focus Groups: Communication Materials
252904	Health Equity Message Testing	Form and Instruction	New	In-Depth Interviews: Communication Materials
252627	CDC Older Adult Injury Prevention Creative Campaign - Survey	Form and Instruction	New	Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002)
252618	Intimate Partner Violence / Sexual Violence Prevention Message Testing	Form and Instruction	New	Focus Group Discussion Guide
252618	Intimate Partner Violence / Sexual Violence Prevention Message Testing	Other-Recruitment and Scheduling	New
252592	Impact Evaluation Demonstration Project DDP/LCP	Form	New	Attachment G. Enrollment Log
252592	Impact Evaluation Demonstration Project DDP/LCP	Form	New	Attachment E. Survey Consent
252592	Impact Evaluation Demonstration Project DDP/LCP	Form and Instruction	New	Attachment D. Screener and Survey
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B2 Client Screener
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B1 Client Screener
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B2 Client Recruitment Script
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B1 Client Recruitment Script
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	In-depth Interview Guide
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	Clinic Staff In-depth Interview Consent Script
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B2 Applicant Consent Script (Child's Blood Test)
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B1 Applicant Consent Script (Chest X-Ray)
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B1 Applicant Intercept Interview Guide
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B2 Moving to the United States and Your Health
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	B1 Your Health and Moving to the United States
252510	PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form	New	Educational Video (script)
251679	Tick- and Mosquito-borne Disease Prevention Message Evaluation	Form and Instruction	New	Focus Group Discussion Guide
251679	Tick- and Mosquito-borne Disease Prevention Message Evaluation	Form and Instruction	New	Focus Group Invitation
251679	Tick- and Mosquito-borne Disease Prevention Message Evaluation	Form and Instruction	New	Focus Group Screening Form

ICR Details

OMB Control No: 0920-0572	ICR Reference No: 202108-0920-006
Status: Historical Active	Previous ICR Reference No: 201806-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0572
Title: CDC and ATSDR Health Message Testing System
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/07/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2021
Terms of Clearance: Previous terms continue: Approved consistent with understanding that for each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	10/31/2021
Responses	55,575	0	55,575
Time Burden (Hours)	7,410	0	7,410
Cost Burden (Dollars)	0	0	0

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Abstract: CDC must communicate about hazards, outbreaks and other emergencies that present an urgent health threat to the public. Untested messages can waste communication resources and opportunities because the messages can be perceived as unclear or irrelevant. OADC-CDC requests a reinstatement without change for the generic clearance for an expedited review of items to be used in health message testing to ensure the public will understand health messages and take recommended action.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 28354	05/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 4472	08/13/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 27

table that charts list of burden

IC Title	Form No.	Form Name
CDC Older Adult Injury Prevention Creative Campaign - Survey	0920-22EC	Attachment 1_Still Going Strong 2021-2022 Survey Questions 1.19.22 (002)
CDC Screen for Life Pretesting Focus Groups	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screen For Life Focus Group Screener - English ,   Screen For Life Focus Group Screener - Spanish ,   Screen For Life Focus Group Consent - English ,   Screen For Life Focus Group Consent - Spanish ,   Screen For Life Focus Group Discussion Guide - English ,   Screen For Life Focus Group Discussion Guide - Spanlish
Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Formative Focus Group Research	0920-22JE, 0920-22JE	Attachment B. Consumer Focus Group Participant Screener ,   Attachment C. Health Provider Focus Group Participant Screener
DNPAO Message and Materials Testing	0920-22IZ, 0920-22IZ	Screener ,   Discussion Guide
Dating Matters - Rebranding	0920-22IO	Att. 1_ DM FGD recruitment & Screening form
Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign	0920-22FW, 0920-22FW, 0920-22FW, 0920-22FW	Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed ,   Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed ,   Attachment 5. Appendix D. HCP Survey Instrument for Exposed ,   Attachment 6. Appendix E. HCP Survey Instrument for Unexposed
Health Equity Message Testing	0920-0572, 0920-0572	In-Depth Interviews: Communication Materials ,   Focus Groups: Communication Materials
Impact Evaluation Demonstration Project DDP/LCP	0920-22DZ, 0920-22DZ, 0920-22DZ	Attachment D. Screener and Survey ,   Attachment E. Survey Consent ,   Attachment G. Enrollment Log
Intimate Partner Violence / Sexual Violence Prevention Message Testing	None	Focus Group Discussion Guide
Message and Materials Testing to Expand Essentials for Parenting	0920-22EZ, 0920-22EZ	Recruitment Screener ,   Focus Group Discussion
PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Educational Video (script) ,   B1 Your Health and Moving to the United States ,   B2 Moving to the United States and Your Health ,   B1 Applicant Intercept Interview Guide ,   B1 Applicant Consent Script (Chest X-Ray) ,   B2 Applicant Consent Script (Child's Blood Test) ,   Clinic Staff In-depth Interview Consent Script ,   In-depth Interview Guide ,   B1 Client Recruitment Script ,   B2 Client Recruitment Script ,   B1 Client Screener ,   B2 Client Screener
Sexual health communication among young adults.	0920-22FQ	B.DSTDP_sexual comms young adults_Informed consent_Screener_Questionnaire
Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs)	0920-0572, 0920-0572	Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Survey ,   Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Screener
Tick- and Mosquito-borne Disease Prevention Message Evaluation	0920-0572, 0920-0572, 0920-0572	Focus Group Screening Form ,   Focus Group Invitation ,   Focus Group Discussion Guide
[OADC] (genIC) Materials Testing of the MyMobility Plan (MMP) and Associated Materials	0920-0572, 0920-0572, 0920-20572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screener (24CQ) ,   Consent Form Main Sample (24CQ) ,   Consent Form Tribal Sample (24CQ) ,   Baseline Survey (24CQ) ,   Weekly Surveys Treatment Group (24CQ) ,   Weekly Surveys Control Group (24CQ) ,   Follow-Up Survey (24CQ) ,   Tribal Survey (24CQ) ,   Baseline Survey (24CQ) Edited ,   Tribal Survey (24CQ) Edited
[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Screener for Physical Activity Ads Survey ,   Screener for Sugary Drinks Ads Survey ,   Screener for Infant and Toddler Nutrition Ads Survey ,   Survey for Physical Activity Ads ,   Survey for Sugary Drinks Ads ,   Survey for Infant and Toddler Nutrition Ads
[OADC] Centers for Disease Control and Prevention (CDC) Inside Knowledge (IK) Material Testing	0920-0572, 0920-0572	CDC Inside Knowledge Message Testing ,   Programmed Message Test Online Version (24GY)
[OADC] DSMES Playbook Survey at ADCES Exhibit Hall	0920-0572	ADCES Exhibit Hall Playbook Survey
[OADC] Developing and Testing New Infographics for Health Equity	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	General Population Screening Questionnaire ,   Screening Questionnaire ,   General Population Quantitative Testing Instrument ,   Public Health Professionals Quantitative Testing Instrument ,   Qualitative Focus Group Discussion Guide – All Audiences
[OADC] Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing	0920-0572, 0920-0572, 0920-0572	Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Screener (24FF) ,   Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Interview Guide (24FF) ,   Division of Nutrition, Physical Activity, and Obesity Qualitative Message and Materials Testing _ Small Group Discussion Guide (24FF)
[OADC] Formative Evaluation to Assess the Effectiveness of Excessive Alcohol Use Prevention Messages - Public Health Stakeholder Focus Groups	0920-23DS, 0920-23DS	Attachment 8_Online Panel Survey_FINAL (002) ,   Attachment 4_Focus Group Consent Form_FINAL
[OADC] HEADS UP! Parents Messaging Concussion Care Message Materials Testing	0920-23CH	Attachment C_FGD screener
[OADC] In Depth Interviews with Obstetric Nurses and Obstetric Nurse Practitioners to Test Hear Her Campaign Materials	0920-23HZ, 0920-23HZ	Interview Guide ,   Screening/Interview Guide
[OADC] Infant Feeding Message Testing in Radiation Emergencies	n/a, n/a	Infant Feeding Screening Instrument ,   Infant Feeding Moderators Guide
[OADC] One Health Office Healthy Pets, Healthy People Message Testing
[OADC] Still Going Strong Campaign Expansion Pilot Testing Survey	n/a, n/a, n/a	Survey Invitation ,   General Older Adults Survey ,   Tribal Elders Survey
[OC] DCPC Screen for Life	0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920--0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572, 0920-0572	Recruitment Language - English ,   Recruitment Language - Spanish ,   Screener - English_paper ,   Screener - English_online ,   Screener - Spanish_paper ,   Screener - Spanish_online ,   Informed Consent - English ,   Informed Consent - Spanish ,   Questionnaire-English_paper ,   Questionnaire-English_online ,   Questionnaire-Spanish_paper ,   Questionnaire-Spanish_online

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	55,575	55,575	0	0	0	0
Annual Time Burden (Hours)	7,410	7,410	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,550,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/31/2021

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