[NCEZID] Communication Evaluation Assessing Foodborne, Waterborne and Mycotic Disease Prevention

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 273434

Documents and Forms

Document Name Document Type
Form 0920-1154 [NCEZID] Communication Evaluation Assessing Foodborne, Waterborne and Mycotic Disease Prevention Form and Instruction
Form 0920-1154 [NCEZID] Communication Evaluation Assessing Foodborne, Waterborne and Mycotic Disease Prevention Form and Instruction
0920-1154 Eligibility Screener - Focus Group Attachment 1 - Eligibility Screener_FG.docx Form and Instruction
0920-1154 Eligibility Screener - Focus Group Attachment 1 - Eligibility Screener_FG.docx Form and Instruction
0920-1154 Eligible Participant Screener - Focus Group Attachment 3 - Eligible Participant Screener_FG.docx Form and Instruction
0920-1154 Eligible Participant Screener - Focus Group Attachment 3 - Eligible Participant Screener_FG.docx Form and Instruction
0920-1154 Eligibility Screener - Survey Attachment 9 - Eligibility Screener for Rapid Survey.docx Form and Instruction
0920-1154 Eligibility Screener - Survey Attachment 9 - Eligibility Screener for Rapid Survey.docx Form and Instruction
0920-1154 Focus Group Moderator Guide Attachment 8 - Focus Group Moderator Guide.docx Form and Instruction
0920-1154 Focus Group Moderator Guide Attachment 8 - Focus Group Moderator Guide.docx Form and Instruction
0920-1154 Rapid Online Survey Attachment 11 - Rapid Survey.docx Form and Instruction
0920-1154 Rapid Online Survey Attachment 11 - Rapid Survey.docx Form and Instruction
Attachment 2 - Recruitment Materials_FG.docx Recruitment Materials - FG IC Document
Attachment 2 - Recruitment Materials_FG.docx Recruitment Materials - FG IC Document
Attachment 5 - Respondent Consent Form_FG.docx Consent Form - FG IC Document
Attachment 5 - Respondent Consent Form_FG.docx Consent Form - FG IC Document
Attachment 6 - Standard Invitation_FG.docx Standard Invitation - FG IC Document
Attachment 6 - Standard Invitation_FG.docx Standard Invitation - FG IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Participant Confirmation Email - FG IC Document
Attachment 7 - Participant Confirmation Email_FG.docx Participant Confirmation Email - FG IC Document
Attachment 13 - Recruitment Materials_Survey.docx Recruitment Materials - Survey IC Document
Attachment 13 - Recruitment Materials_Survey.docx Recruitment Materials - Survey IC Document
Attachment 12 - Respondent Consent Form_Survey.docx Consent Form - Survey IC Document
Attachment 12 - Respondent Consent Form_Survey.docx Consent Form - Survey IC Document
Attachment 15 - Messages to be tested.docx Test Messages IC Document
Attachment 15 - Messages to be tested.docx Test Messages IC Document
Attachment 16- Human Subjects Determination.pdf Non-Research Determination IC Document
Attachment 16- Human Subjects Determination.pdf Non-Research Determination IC Document
Attachment 4 - Privacy Agreement.docx Privacy Agreement IC Document
Attachment 4 - Privacy Agreement.docx Privacy Agreement IC Document
GenIC Request_DFWED.docx GenIC Request IC Document
GenIC Request_DFWED.docx GenIC Request IC Document
Supporting Statement A.docx Supporting Statement A IC Document
Supporting Statement A.docx Supporting Statement A IC Document
Supporting Statement B.docx Supporting Statement B IC Document
Supporting Statement B.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCEZID] Communication Evaluation Assessing Foodborne, Waterborne and Mycotic Disease Prevention	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154	Eligibility Screener - Focus Group	Attachment 1 - Eligibility Screener_FG.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Eligible Participant Screener - Focus Group	Attachment 3 - Eligible Participant Screener_FG.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Eligibility Screener - Survey	Attachment 9 - Eligibility Screener for Rapid Survey.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Focus Group Moderator Guide	Attachment 8 - Focus Group Moderator Guide.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1154	Rapid Online Survey	Attachment 11 - Rapid Survey.docx	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,794	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	6,794	6,794
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Materials - FG	Attachment 2 - Recruitment Materials_FG.docx	12/30/2024
Consent Form - FG	Attachment 5 - Respondent Consent Form_FG.docx	12/30/2024
Standard Invitation - FG	Attachment 6 - Standard Invitation_FG.docx	12/30/2024
Participant Confirmation Email - FG	Attachment 7 - Participant Confirmation Email_FG.docx	12/30/2024
Recruitment Materials - Survey	Attachment 13 - Recruitment Materials_Survey.docx	12/30/2024
Consent Form - Survey	Attachment 12 - Respondent Consent Form_Survey.docx	12/30/2024
Test Messages	Attachment 15 - Messages to be tested.docx	12/30/2024
Non-Research Determination	Attachment 16- Human Subjects Determination.pdf	12/30/2024
Privacy Agreement	Attachment 4 - Privacy Agreement.docx	12/30/2024
GenIC Request	GenIC Request_DFWED.docx	12/30/2024
Supporting Statement A	Supporting Statement A.docx	12/30/2024
Supporting Statement B	Supporting Statement B.docx	12/30/2024

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