Information Collection

[NCEZID] (genIC) Healthcare Provider Communication Evaluation: Assessing Foodborne Illness and Waterborne Illness Prevention Messages, Knowledge, and Attitudes

IC 264920 under ICR 202503-0920-028 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 0920-1154 [NCEZID] (genIC) Healthcare Provider Communication Evaluation: Assessing Foodborne Illness and Waterborne Illness Prevention Messages, Knowledge, and Attitudes Form
Form 0920-1154 [NCEZID] (genIC) Healthcare Provider Communication Evaluation: Assessing Foodborne Illness and Waterborne Illness Prevention Messages, Knowledge, and Attitudes Form
0920-1154 Screening/Eligibility Form for Interviews/Focus Groups ( Attachment #1 - HCP Eligibility Screener.docx Form
0920-1154 Screening/Eligibility Form for Interviews/Focus Groups ( Attachment #1 - HCP Eligibility Screener.docx Form
0920-1154 Eligible Participant Screener (24CU) Attachment #3 - HCP Eligible Participant Screener.docx Form and Instruction
0920-1154 Eligible Participant Screener (24CU) Attachment #3 - HCP Eligible Participant Screener.docx Form and Instruction
0920-1154 Moderator or Interviewer Guide (24CU) Attachment #8 - HCP Interview Guide.docx Form and Instruction
0920-1154 Moderator or Interviewer Guide (24CU) Attachment #8 - HCP Interview Guide.docx Form and Instruction
0920-1154 MESSAGES to be TESTED (24CU) Attachment #9- messages to be tested HCP.docx Form and Instruction
0920-1154 MESSAGES to be TESTED (24CU) Attachment #9- messages to be tested HCP.docx Form and Instruction
Supporting Statement A.docx SSA (24CU) IC Document
Supporting Statement A.docx SSA (24CU) IC Document
Supporting Statement B.docx SSB (24CU) IC Document
Supporting Statement B.docx SSB (24CU) IC Document
GenIC Request_.docx Request for genIC Approval CDC/ATSDR Formative Research and Tool Development (24CU) IC Document
GenIC Request_.docx Request for genIC Approval CDC/ATSDR Formative Research and Tool Development (24CU) IC Document
Attachment #2 - Recruitment Materials.docx Recruitment Materials (24CU) IC Document
Attachment #2 - Recruitment Materials.docx Recruitment Materials (24CU) IC Document
Attachment #4 - Privacy Agreement.docx Privacy Agreement_Project Staff (24CU) IC Document
Attachment #4 - Privacy Agreement.docx Privacy Agreement_Project Staff (24CU) IC Document
Attachment #5 - Respondent Consent Form.docx Respondent Consent Form (24CU) IC Document
Attachment #5 - Respondent Consent Form.docx Respondent Consent Form (24CU) IC Document
Attachment #6 - Standard Invitation.docx Invitation_Standard (24CU) IC Document
Attachment #6 - Standard Invitation.docx Invitation_Standard (24CU) IC Document
Attachment #7 - Participant Confirmation Email.docx Participant Confirmation Email (24CU) IC Document
Attachment #7 - Participant Confirmation Email.docx Participant Confirmation Email (24CU) IC Document
Attachment #10- Human Subjects Determination.pdf Determination of Non-applicability of Human Subjects Regulations (24CU) IC Document
Attachment #10- Human Subjects Determination.pdf Determination of Non-applicability of Human Subjects Regulations (24CU) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCEZID] (genIC) Healthcare Provider Communication Evaluation: Assessing Foodborne Illness and Waterborne Illness Prevention Messages, Knowledge, and Attitudes	Agency IC Tracking Number:	0920-1154-24CU

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	0920-1154	Screening/Eligibility Form for Interviews/Focus Groups (24CU)	Attachment #1 - HCP Eligibility Screener.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-1154	Eligible Participant Screener (24CU)	Attachment #3 - HCP Eligible Participant Screener.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-1154	Moderator or Interviewer Guide (24CU)	Attachment #8 - HCP Interview Guide.docx	Yes	No	Fillable Fileable
Form and Instruction	0920-1154	MESSAGES to be TESTED (24CU)	Attachment #9- messages to be tested HCP.docx	No		Paper 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: 360	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	69	69
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA (24CU)	Supporting Statement A.docx	02/06/2024
SSB (24CU)	Supporting Statement B.docx	02/06/2024
Request for genIC Approval CDC/ATSDR Formative Research and Tool Development (24CU)	GenIC Request_.docx	02/06/2024
Recruitment Materials (24CU)	Attachment #2 - Recruitment Materials.docx	02/06/2024
Privacy Agreement_Project Staff (24CU)	Attachment #4 - Privacy Agreement.docx	02/06/2024
Respondent Consent Form (24CU)	Attachment #5 - Respondent Consent Form.docx	02/06/2024
Invitation_Standard (24CU)	Attachment #6 - Standard Invitation.docx	02/06/2024
Participant Confirmation Email (24CU)	Attachment #7 - Participant Confirmation Email.docx	02/06/2024
Determination of Non-applicability of Human Subjects Regulations (24CU)	Attachment #10- Human Subjects Determination.pdf	02/06/2024

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