[NCIPC] Adverse Childhood Experiences Prevention Message Development

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 270987

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Other-Screenshots
Other-Screenshots
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

[NCIPC] Adverse Childhood Experiences Prevention Message Development 0920-1154-24IP
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 ACEs Survey and Consent - Revised 25MAR2025 Att 1. ACEs Survey and Consent__OMB Edited 12.2.24.docx N/A Yes Yes Fillable Fileable
Other-Screenshots Att 2. ACEs Survey Screenshots_8.7.24ka.docx No   Printable Only
Form and Instruction 0920-1154 ACEs Focus Group Participant Screener - Revised 25MAR2025 Att 3. ACEs Focus Group Participant Screener_OMB Edited12.2.24.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1154 (24IP) ACEs Focus Group Consent Form Att 4. ACEs Focus Group Consent_v3.docx Yes Yes Fillable Fileable
Instruction Att 5. ACEs Focus Group Guide_v2.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 (24IP) ACEs Partner Interview Consent Form Att 6. ACEs Partner Interview Consent Form_v3.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 (24IP) ACEs Partner Interview Guide Att 7. ACEs Partner Interview Guide_v2.docx Yes Yes Fillable Fileable

Health Health Care Services

 

200 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 200 0 0 0 0 200
Annual IC Time Burden (Hours) 86 0 0 0 0 86
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA (24IP) ACE Prevention Message SSA_OMB Corrected 12.02.24.docx 12/11/2024
SSB (24IP) ACE Prevention Message SSB__8.7.24ka.docx 09/17/2024
ACEs Messages for Testing (24IP) Att 8. ACEs Messages for Testing_v1.docx 09/17/2024
Project Determination (24IP) Att 10. ACEs Non-Research determination.docx 09/17/2024
Revised Supporting Statement B 25MAR2025 ACE Prevention Message SSB_tracked changes.docx 03/25/2025
Change Request Memo 25MAR2025 ACEs_0920-1154_Change Request Memo - EO14168.docx 03/25/2025
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