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Federal forms, ICRs, and supporting documents

Information Collection

Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)

IC 263672 under ICR 202507-0920-001 · OMB 0920-1154.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1154
Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)		 Form and Instruction
Form 0920-1154
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Broadcast Radio Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)		 Form and Instruction
Form 0920-1154
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Digital Ad Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)		 Form and Instruction
Attachment 3 - Broadcast Radio Screenshots.docx Other-Screenshots - Broadcast Radio
Attachment 3 - Broadcast Radio Screenshots.docx Other-Screenshots - Broadcast Radio
Attachment 4 - Digital Ad Survey Screenshots.docx Other-Screenshots - Digital Ad
Attachment 4 - Digital Ad Survey Screenshots.docx Other-Screenshots - Digital Ad
Attachment 5 - Recruitment Materials.docx Instruction
Attachment 5 - Recruitment Materials.docx Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone
Attachment 1 - Survey Instrument -Broadcast radio.docx 		Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone
Attachment 1 - Survey Instrument -Broadcast radio.docx 		Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone
Attachment 2 - Survey Instrument -Digital Ad.docx 		Form and Instruction
0920-1154 Stop Overdose Campaign Evaluation: Fentanyl and Naloxone
Attachment 2 - Survey Instrument -Digital Ad.docx 		Form and Instruction
SSA_11.27.23.docx
SSA		IC Document
SSA_11.27.23.docx
SSA		IC Document
Supporting Statement B.docx
SSB		IC Document
Supporting Statement B.docx
SSB		IC Document
Attachment 6 Privacy Act-Determination.pdf
Privacy Act Determination		IC Document
Attachment 6 Privacy Act-Determination.pdf
Privacy Act Determination		IC Document
Attachment 7. IRB Determination Letter.pdf
IRB Determination		IC Document
Attachment 7. IRB Determination Letter.pdf
IRB Determination		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction 0920-1154 Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Yes Yes Fillable Fileable
Other-Screenshots - Broadcast Radio No   Paper Only
Other-Screenshots - Digital Ad No   Printable Only
Instruction No   Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 1,750 0 0 0 0 1,750
Annual IC Time Burden (Hours) 379 0 0 0 0 379
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
SSA 11/27/2023
SSB 11/27/2023
Privacy Act Determination 11/27/2023
IRB Determination 11/27/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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