Information Collection

Formative Research for Spanish-Language Drug Overdose Messages

IC 259194 under ICR 202210-0920-013 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Formative Research for Spanish-Language Drug Overdose Messages	Form and Instruction
Attachment 7 - Follow Up Email for Qualitative Data Collection and Survey_final.docx	Instruction
Attachment 8 - Recruitment Materials_FINAL_final.docx	Instruction
Qualitative Eligibility Screener (Phone) Attachment 1.1_ Qualitative Eligibility Screener (Phone)_final.docx	Form and Instruction
Qualitative Eligibility Screener (Online) Attachment 1_ Qualitative Eligibility Screener (Online)_final.docx	Form and Instruction
Focus Group Moderator Guide Attachment 2 - Focus Group Moderator Guide-9.2_final.docx	Form and Instruction
Interview Guide Attachment 3 - Interview Guide 1-30_final.docx	Form and Instruction
Online Survey Attachment 4 - Online Survey_final.docx	Form and Instruction
Respondent Consent Form and Participants Email Attachment 6 - Respondent Consent Form and Participants email_final.docx	Form and Instruction
SSA_Formative Research Spanish DO Messages 1-30 CLEAN_final.docx SSA	IC Document
Attachment 2.1 Zoom Poll Example.png Zoom Poll Example	IC Document
Attachment 5_Spanish Message Testing_PIA.pdf Privacy Assessment	IC Document
Attachment 5.1- Privacy Agreement 9.2.docx Privacy Agreement	IC Document
Attachment 9 - Follow Up Message for Survey Collection 9.2.docx Follow Up Message for Survey Collection	IC Document
Attachment 10 - Messages and Materials for Testing 9.2.docx Messages and Materials for Testing	IC Document
Attachment 11 - Recruitment Materials 9.2.docx Recruitment Materials	IC Document
Attachment 12 - DOCR_IRB Determination 9.2.pdf Research Determination	IC Document
GenIC Request_Formative Research Spanish DO Messages 10.4_final.docx GenIC Request Template	IC Document
Attachment 4.1 Online Survey Screenshots Fentanyl and Naloxone.pdf Online Survey Screenshots Fentanyl and Naloxone	IC Document
Attachment 4.2 Online Survey Screenshots Stigma and Polysubstance Use.pdf Online Survey Screenshots Stigma and Polysubstance Use	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Formative Research for Spanish-Language Drug Overdose Messages

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 and Instruction	n/a	Qualitative Eligibility Screener (Phone)	Attachment 1.1_ Qualitative Eligibility Screener (Phone)_final.docx	No		Fillable Fileable
Form and Instruction	n/a	Qualitative Eligibility Screener (Online)	Attachment 1_ Qualitative Eligibility Screener (Online)_final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Focus Group Moderator Guide	Attachment 2 - Focus Group Moderator Guide-9.2_final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Interview Guide	Attachment 3 - Interview Guide 1-30_final.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Online Survey	Attachment 4 - Online Survey_final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Respondent Consent Form and Participants Email	Attachment 6 - Respondent Consent Form and Participants email_final.docx	Yes	Yes	Fillable Fileable
Instruction			Attachment 7 - Follow Up Email for Qualitative Data Collection and Survey_final.docx	No		Fillable Fileable
Instruction			Attachment 8 - Recruitment Materials_FINAL_final.docx	Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,726

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,726	4,726
Annual IC Time Burden (Hours)	447	447
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA	SSA_Formative Research Spanish DO Messages 1-30 CLEAN_final.docx	03/16/2023
Zoom Poll Example	Attachment 2.1 Zoom Poll Example.png	03/16/2023
Privacy Assessment	Attachment 5_Spanish Message Testing_PIA.pdf	03/16/2023
Privacy Agreement	Attachment 5.1- Privacy Agreement 9.2.docx	03/16/2023
Follow Up Message for Survey Collection	Attachment 9 - Follow Up Message for Survey Collection 9.2.docx	03/16/2023
Messages and Materials for Testing	Attachment 10 - Messages and Materials for Testing 9.2.docx	03/16/2023
Recruitment Materials	Attachment 11 - Recruitment Materials 9.2.docx	03/16/2023
Research Determination	Attachment 12 - DOCR_IRB Determination 9.2.pdf	03/16/2023
GenIC Request Template	GenIC Request_Formative Research Spanish DO Messages 10.4_final.docx	03/16/2023
Online Survey Screenshots Fentanyl and Naloxone	Attachment 4.1 Online Survey Screenshots Fentanyl and Naloxone.pdf	03/16/2023
Online Survey Screenshots Stigma and Polysubstance Use	Attachment 4.2 Online Survey Screenshots Stigma and Polysubstance Use.pdf	03/16/2023

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