Information Collection

[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing

IC 261449 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⚠️ Notice: This information collection may be referencing outdated material.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 Screener for Physical Activity Ads Survey [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
Form 0920-0572 Screener for Sugary Drinks Ads Survey [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
Form 0920-0572 Screener for Infant and Toddler Nutrition Ads Survey [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
Form 0920-0572 Survey for Physical Activity Ads [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
Form 0920-0572 Survey for Sugary Drinks Ads [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
Form 0920-0572 Survey for Infant and Toddler Nutrition Ads [OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing	Form and Instruction
0920-0572 Screener for Physical Activity Ads Survey Attachment C1 Screener for Physical Activity Ads Survey.docx	Form and Instruction
0920-0572 Screener for Sugary Drinks Ads Survey Attachment D1 Screener for Sugary Drinks Ads Survey.docx	Form and Instruction
0920-0572 Screener for Infant and Toddler Nutrition Ads Survey Attachment E1 Screener for Infant and Toddler Nutrition Ads Survey.docx	Form and Instruction
0920-0572 Survey for Physical Activity Ads Attachment C2 Survey for Physical Activity Ads.docx	Form and Instruction
0920-0572 Survey for Sugary Drinks Ads Attachment D2 Survey for Sugary Drinks Ads.docx	Form and Instruction
0920-0572 Survey for Infant and Toddler Nutrition Ads Attachment E2 Survey for Infant and Toddler Nutrition Ads.docx	Form and Instruction
ATTACHMENT A- Supplement to HMTS Expedited Review - SCHMC Ad Testing 2023 ( revised 5-9-23).docx List of attachments to HMTS Expedited Review Form	IC Document
ATTACHMENT B-Ads to be tested - SCHMC Ad Testing 2023- 3-30-23.docx Ads to be tested	IC Document
Attachment C3 Screen Captures of Screener and Survey for Physical Activity Ads.docx Screen Captures of Screener and Survey for Physical Activity Ads	IC Document
Attachment D3 Screen Captures of Screener and Survey for Sugary Drinks Ads.docx Screen Captures of Screener and Survey for Sugary Drinks Ads	IC Document
Attachment E3 Screen Captures of Screener and Survey for Infant and Toddler Nutrition Ads.docx Screen Captures of Screener and Survey for Infant and Toddler Nutrition Ads	IC Document
HMTS Form- SCHMC Ad Testing 2023- rev 5-9-2023.docx HMTS Expedited Review Form	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[OADC] CDC/DNPAO State and Community Health Media Cetner Ad Testing

Agency IC Tracking Number:

0920-0572-23HJ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,425

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	7,425	7,425
Annual IC Time Burden (Hours)	1,725	1,725
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
List of attachments to HMTS Expedited Review Form		08/04/2023
Ads to be tested		08/04/2023
Screen Captures of Screener and Survey for Physical Activity Ads		08/09/2023
Screen Captures of Screener and Survey for Sugary Drinks Ads		08/09/2023
Screen Captures of Screener and Survey for Infant and Toddler Nutrition Ads		08/09/2023
HMTS Expedited Review Form		08/09/2023

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

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