[NCEZID] Harmful Algal Blooms Communication Evaluation

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 265153

Documents and Forms

Document Name Document Type
Form 0920-1154 [NCEZID] Harmful Algal Blooms Communication Evaluation Form
Form 0920-1154 [NCEZID] Harmful Algal Blooms Communication Evaluation Form
Attachment 5 - Respondent Consent Form_FG.docx Instruction
Attachment 5 - Respondent Consent Form_FG.docx Instruction
0920-1154 Screening/Eligibility Form for Focus Groups (24CX) Attachment 1 - Eligibility Screener.docx Form
0920-1154 Screening/Eligibility Form for Focus Groups (24CX) Attachment 1 - Eligibility Screener.docx Form
0920-1154 Eligible Participant Screener for Focus Group (24CX) Attachment 3 - Eligible Participant Screener_FG.docx Form
0920-1154 Eligible Participant Screener for Focus Group (24CX) Attachment 3 - Eligible Participant Screener_FG.docx Form
0920-1154 Focus Group Moderator Guide (24CX) Attachment 8 - Focus Group Moderator Guide .docx Form and Instruction
0920-1154 Focus Group Moderator Guide (24CX) Attachment 8 - Focus Group Moderator Guide .docx Form and Instruction
Attachment 2 - Recruitment Materials_FG.docx Recruitment Language (General and Post Copy) IC Document
Attachment 2 - Recruitment Materials_FG.docx Recruitment Language (General and Post Copy) IC Document
Attachment 4 - Privacy Agreement.docx Privacy Agreement (24CX) IC Document
Attachment 4 - Privacy Agreement.docx Privacy Agreement (24CX) IC Document
Attachment 6 - Standard Invitation_FG .docx Invitation (24CX) IC Document
Attachment 6 - Standard Invitation_FG .docx Invitation (24CX) IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Participant Confirmation Email (24CX) IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Participant Confirmation Email (24CX) IC Document
Attachment 9 - Messages to be tested HABs.docx Messages to be Tested (HABs Focus Group) IC Document
Attachment 9 - Messages to be tested HABs.docx Messages to be Tested (HABs Focus Group) IC Document
Attachment 10- Human Subjects Determination.pdf Human Subjects Determination IC Document
Attachment 10- Human Subjects Determination.pdf Human Subjects Determination IC Document
GenIC Request HAB Communication Evaluation.docx Request for Approval under the “Generic Clearance 0920-1154" for "genI (24CX) IC Document
GenIC Request HAB Communication Evaluation.docx Request for Approval under the “Generic Clearance 0920-1154" for "genI (24CX) IC Document
SSA 021324.docx SSA (24CX) IC Document
SSA 021324.docx SSA (24CX) IC Document
Supporting Statement B.docx SSB (24CX) IC Document
Supporting Statement B.docx SSB (24CX) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCEZID] Harmful Algal Blooms Communication Evaluation	Agency IC Tracking Number:	0920-1154-24CX

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 Focus Groups (24CX)	Attachment 1 - Eligibility Screener.docx	Yes	Yes	Fillable Fileable
Form	0920-1154	Eligible Participant Screener for Focus Group (24CX)	Attachment 3 - Eligible Participant Screener_FG.docx	Yes	Yes	Fillable Fileable
Instruction			Attachment 5 - Respondent Consent Form_FG.docx	No		Paper Only
Form and Instruction	0920-1154	Focus Group Moderator Guide (24CX)	Attachment 8 - Focus Group Moderator Guide .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: 420	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	420	420
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Language (General and Post Copy)	Attachment 2 - Recruitment Materials_FG.docx	02/12/2024
Privacy Agreement (24CX)	Attachment 4 - Privacy Agreement.docx	02/12/2024
Invitation (24CX)	Attachment 6 - Standard Invitation_FG .docx	02/12/2024
Participant Confirmation Email (24CX)	Attachment 7 - Participant Confirmation Email_FG.docx	02/12/2024
Messages to be Tested (HABs Focus Group)	Attachment 9 - Messages to be tested HABs.docx	02/13/2024
Human Subjects Determination	Attachment 10- Human Subjects Determination.pdf	02/13/2024
Request for Approval under the “Generic Clearance 0920-1154" for "genI (24CX)	GenIC Request HAB Communication Evaluation.docx	02/13/2024
SSA (24CX)	SSA 021324.docx	02/13/2024
SSB (24CX)	Supporting Statement B.docx	02/13/2024

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