Information Collection

[NCZEID] Lyme Disease Creative and Message Testing Focus Groups

IC 275557 under ICR 202507-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
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 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 3_WS-NCEZID_Lyme Disease FG Guide.docx Guide IC Document
Attachment 4_Human Subjects Determination Memo.pdf Determination 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
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_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 A.docx SSA IC Document
WS-NCEZID_Lyme Disease_OMB Supporting Statement B.docx SSB 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

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	Previously Approved
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

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.

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