Information Collection

CDC Screen for Life Pretesting Focus Groups

IC 254285 under ICR 202108-0920-006 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0572 Screen For Life Focus Group Screener - English CDC Screen for Life Pretesting Focus Groups	Form and Instruction
Form 0920-0572 Screen For Life Focus Group Screener - Spanish CDC Screen for Life Pretesting Focus Groups	Form and Instruction
Form 0920-0572 Screen For Life Focus Group Consent - English CDC Screen for Life Pretesting Focus Groups	Form and Instruction
Form 0920-0572 Screen For Life Focus Group Consent - Spanish CDC Screen for Life Pretesting Focus Groups	Form and Instruction
Form 0920-0572 Screen For Life Focus Group Discussion Guide - English CDC Screen for Life Pretesting Focus Groups	Form and Instruction
Form 0920-0572 Screen For Life Focus Group Discussion Guide - Spanlish CDC Screen for Life Pretesting Focus Groups	Form and Instruction
0920-0572 Screen For Life Focus Group Screener - English 2A CDC SFL FG Screener ENGLISH 052522.docx	Form and Instruction
0920-0572 Screen For Life Focus Group Screener - Spanish 2B CDC SFL FG Screener SPANISH 052522.docx	Form and Instruction
0920-0572 Screen For Life Focus Group Consent - English 4A CDC SFL FG Informed Consent ENGLISH 052522.docx	Form and Instruction
0920-0572 Screen For Life Focus Group Consent - Spanish 4B CDC SFL FG Informed Consent SPANISH 052522.docx	Form and Instruction
0920-0572 Screen For Life Focus Group Discussion Guide - English 5A CDC SFL FG Discussion Guide ENGLISH 052522.docx	Form and Instruction
0920-0572 Screen For Life Focus Group Discussion Guide - Spanlish 5B CDC SFL FG Discussion Guide SPANISH 052522.docx	Form and Instruction
3A CDC SFL FG Emails ENGLISH 052522.docx Screen For Life Focus Group Emails - English	IC Document
3B CDC SFL FG Emails SPANISH 052522.docx Screen For Life Focus Group Emails - Spanlish	IC Document
6A CDC SFL FG Thank You Email ENGLISH 052522.docx Screen For Life Focus Group Thank You Email - English	IC Document
6B CDC SFL FG Thank You Email SPANISH 052522.docx Screen For Life Focus Group Thank You Email - Spanish	IC Document
SFL _ Storyboards.pdf Messages to be Tested - StoryBoards_English	IC Document
SFL _ Storyboards - Spanish (04_28).pdf Messages to be Tested - StoryBoards_Spanish	IC Document
1 CDC SFL FG Background Information 052522.docx Screen For Life - Background Information	IC Document
HMTSExpeditedReviewForm_032322.pdf Health Message Testing System (HMTS) Expedited Review Form	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CDC Screen for Life Pretesting Focus Groups

Agency IC Tracking Number:

0920-0572-22GK

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192

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	192	192
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screen For Life Focus Group Emails - English		06/24/2022
Screen For Life Focus Group Emails - Spanlish		06/24/2022
Screen For Life Focus Group Thank You Email - English		06/24/2022
Screen For Life Focus Group Thank You Email - Spanish		06/24/2022
Messages to be Tested - StoryBoards_English		06/24/2022
Messages to be Tested - StoryBoards_Spanish		06/24/2022
Screen For Life - Background Information		06/24/2022
Health Message Testing System (HMTS) Expedited Review Form		06/24/2022

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

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