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[NCZEID] Lyme Disease Creative and Message Testing Focus Groups
[OS] CDC/ATSDR Formative Research and Tool Development
OMB: 0920-1154
IC ID: 275557
OMB.report
HHS/CDC
OMB 0920-1154
ICR 202507-0920-001
IC 275557
( )
Documents and Forms
Document Name
Document Type
Form 0920-25-0124
[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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCZEID] Lyme Disease Creative and Message Testing Focus Groups
Agency IC Tracking Number:
0920-25-0124
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
0920-25-0124
Lyme Disease Screener
Attachment 1_WS-NCEZID_Lyme Disease FG Screener.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
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
768
0
0
0
0
768
Annual IC Time Burden (Hours)
154
0
0
0
0
154
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Consent Form
Attachment 2_WS-NCEZID_Lyme Disease FG Consent Form.docx
06/03/2025
Guide
Attachment 3_WS-NCEZID_Lyme Disease FG Guide.docx
06/03/2025
Determination
Attachment 4_Human Subjects Determination Memo.pdf
06/03/2025
Concept and Message Testing Stimuli
Attachment 5_Concept and Message Testing Stimuli.pdf
06/03/2025
GenIC Request
WS-NCEZID_Lyme Disease_GenIC Request Form.docx
06/03/2025
SSA
WS-NCEZID_Lyme Disease_OMB Supporting Statement A.docx
06/03/2025
SSB
WS-NCEZID_Lyme Disease_OMB Supporting Statement B.docx
06/03/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.