OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Study to Explore Educational Children's Book in Pediatric Offices

ICR 201308-0920-002 · OMB 0920-0991 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Focus Group Consent Form and Instruction New Available
Focus Group Screener Form New Repair queued
Follow-up Web Survey Form New Available
Web Survey Form New Available
Supplemental 3_Amazing_Me_Final_Version_508_Part2.pdf Supplementary Document Uploaded 2013-08-02 Available
Supporting Statement B_Westat response07122013.docx Supporting Statement B Uploaded 2013-07-22 Available
Supplemental 3_Amazing_Me_Final_Version_508_Part1.pdf Supplementary Document Uploaded 2013-07-29 Available
Supplemental 2 Amazing Me IRB Amendment Form Approval.pdf Supplementary Document Uploaded 2013-07-22 Available
Supplemental 1 Amazing Me IRB Approval Letter.pdf Supplementary Document Uploaded 2013-07-22 Available
60dy_FRN.pdf Supplementary Document Uploaded 2013-07-22 Available
Attachment 1 Applicable Laws or Regulations.docx Supplementary Document Uploaded 2013-07-22 Available
Attachment 4 Amazing Me Parent Follow-Up Contact Survey FINAL Mar 15 2013.docx Supplementary Document Uploaded 2013-07-22 Available
Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx Supplementary Document Uploaded 2013-07-22 Available
SupportingStmnt A_Westat response07122013.docx Supporting Statement A Uploaded 2013-07-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
208017 Focus Group Moderator's Guide Instruction New
208016 Focus Group Consent Form and Instruction New
208015 Focus Group Screener Form New
208014 Follow-up Web Survey Form New
208013 Web Survey Form New
ICR Details
0920-0991 201308-0920-002
Historical Active
HHS/CDC 20096
Study to Explore Educational Children's Book in Pediatric Offices
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/26/2013
Retrieve Notice of Action (NOA) 08/01/2013
  Inventory as of this Action Requested Previously Approved
09/30/2014 12 Months From Approved
1,968 0 0
229 0 0
0 0 0
CDC's NCBDDD will conduct this study to assess the influence of the children's book, Amazing Me in pediatric office settings where the book will be distributed to parents of 3-year-old children, soon to be 3-year olds, and recently turned 4-year olds. The findings will help CDC determine if distribution of the book through RoR/pediatric office settings is an appropriate approach for delivering information about child development to parents and if children's literature is an appropriate approach for reaching parents and caregivers with health related messages.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 20111 04/03/2013
78 FR 44568 07/24/2013
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,968 0 0 1,968 0 0
Annual Time Burden (Hours) 229 0 0 229 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$120,001
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/01/2013