Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 263672

Documents and Forms

Document Name Document Type
Form 0920-1154 Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys) Form and Instruction
Form 0920-1154 Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys) Form and Instruction
Attachment 3 - Broadcast Radio Screenshots.docx Other-Screenshots - Broadcast Radio
Attachment 3 - Broadcast Radio Screenshots.docx Other-Screenshots - Broadcast Radio
Attachment 4 - Digital Ad Survey Screenshots.docx Other-Screenshots - Digital Ad
Attachment 4 - Digital Ad Survey Screenshots.docx Other-Screenshots - Digital Ad
Attachment 5 - Recruitment Materials.docx Instruction
Attachment 5 - Recruitment Materials.docx Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Attachment 1 - Survey Instrument -Broadcast radio.docx Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Attachment 1 - Survey Instrument -Broadcast radio.docx Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Attachment 2 - Survey Instrument -Digital Ad.docx Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Attachment 2 - Survey Instrument -Digital Ad.docx Form and Instruction
SSA_11.27.23.docx SSA IC Document
SSA_11.27.23.docx SSA IC Document
Supporting Statement B.docx SSB IC Document
Supporting Statement B.docx SSB IC Document
Attachment 6 Privacy Act-Determination.pdf Privacy Act Determination IC Document
Attachment 6 Privacy Act-Determination.pdf Privacy Act Determination IC Document
Attachment 7. IRB Determination Letter.pdf IRB Determination IC Document
Attachment 7. IRB Determination Letter.pdf IRB Determination IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)	Agency IC Tracking Number:	0920-1154-24BH

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Broadcast Radio	Attachment 1 - Survey Instrument -Broadcast radio.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Digital Ad	Attachment 2 - Survey Instrument -Digital Ad.docx	Yes	Yes	Fillable Fileable
Other-Screenshots - Broadcast Radio			Attachment 3 - Broadcast Radio Screenshots.docx	No		Paper Only
Other-Screenshots - Digital Ad			Attachment 4 - Digital Ad Survey Screenshots.docx	No		Printable Only
Instruction			Attachment 5 - Recruitment Materials.docx	No		Printable Only

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: 1,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,750	1,750
Annual IC Time Burden (Hours)	379	379
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA	SSA_11.27.23.docx	11/27/2023
SSB	Supporting Statement B.docx	11/27/2023
Privacy Act Determination	Attachment 6 Privacy Act-Determination.pdf	11/27/2023
IRB Determination	Attachment 7. IRB Determination Letter.pdf	11/27/2023

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