Information Collection

[NCZEID] Lyme Disease Creative and Message Testing Focus Groups

IC 275557 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0124 Lyme Disease Screener [NCZEID] Lyme Disease Creative and Message Testing Focus Groups	Form
0920-25-0124 Lyme Disease Screener Attachment 1_WS-NCEZID_Lyme Disease FG Screener.docx	Form
Attachment 2_WS-NCEZID_Lyme Disease FG Consent Form.docx Consent Form	IC Document
Attachment 3_WS-NCEZID_Lyme Disease FG Guide.docx Guide	IC Document
Attachment 4_Human Subjects Determination Memo.pdf Determination	IC Document
Attachment 5_Concept and Message Testing Stimuli.pdf Concept and Message Testing Stimuli	IC Document
WS-NCEZID_Lyme Disease_GenIC Request Form.docx GenIC Request	IC Document
WS-NCEZID_Lyme Disease_OMB Supporting Statement A.docx SSA	IC Document
WS-NCEZID_Lyme Disease_OMB Supporting Statement B.docx SSB	IC Document

IC Title:

[NCZEID] Lyme Disease Creative and Message Testing Focus Groups

Agency IC Tracking Number:

0920-25-0124

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25-0124				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 768

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	768	768
Annual IC Time Burden (Hours)	154	154
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form		06/03/2025
Guide		06/03/2025
Determination		06/03/2025
Concept and Message Testing Stimuli		06/03/2025
GenIC Request		06/03/2025
SSA		06/03/2025
SSB		06/03/2025

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

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