OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Testing Act Early Messages and Materials for "Learn the Signs. Act Early" - Phase II

ICR 201409-0920-002 · OMB 0920-1041 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Act Early Parent Intercept Interview Form New Available
Act Early Parent Intercept Interview Screener Form New Available
Act Early Focus Group Informed Consent Form New Available
Parent Focus Group Screener Form New Available
Attachment 10 project factsheet Rev 1_5_15.docx Supplementary Document Uploaded 2015-01-07 Available
Att 15_IRB Approval Letter.pdf Supplementary Document Uploaded 2014-09-03 Repair queued
Attachment 10 project factsheet Rev 1_5_15.docx Supplementary Document Uploaded 2015-01-07 Available
Att 13_LTSAE Checklist.pdf Supplementary Document Uploaded 2014-09-03 Available
Att 12_LTSAE Booklet.pdf Supplementary Document Uploaded 2014-09-03 Available
Att 11_LTSAE Brochure.pdf Supplementary Document Uploaded 2014-09-03 Available
Att 8_Act Early Parent Intercept Interview Recruitment Script_v2.docx Supplementary Document Uploaded 2014-09-03 Available
Att 4_Act Early Parent Focus Group Recruitment Handout_v2.docx Supplementary Document Uploaded 2014-09-03 Available
Att 3 _Act Early Parent Focus Group Recruitment Poster_v2.docx Supplementary Document Uploaded 2014-09-03 Available
Att 2_60dy_FRN.pdf Supplementary Document Uploaded 2014-09-03 Available
Att 1_Applicable Laws or Regulations.docx Supplementary Document Uploaded 2014-09-03 Available
SupportingStmnt B_OMB Testing Act Early messages and materials_May1_Westat rev.docx Supporting Statement B Uploaded 2014-09-03 Available
SupportingStmnt A_OMB Testing Act Early messages and materials_v2_Westat rev_082614.docx Supporting Statement A Uploaded 2014-09-03 Available
IC Document Collections
IC IDCollectionTypeStatusForm
212933 Act Early Parent Intercept Interview Form New
212932 Act Early Parent Intercept Interview Screener Form New
212931 Act Early Parent Focus Group Moderator's Guide Instruction New
212930 Act Early Focus Group Informed Consent Form New
212929 Parent Focus Group Screener Form New
ICR Details
0920-1041 201409-0920-002
Historical Active
HHS/CDC 14AAO
Testing Act Early Messages and Materials for "Learn the Signs. Act Early" - Phase II
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/12/2015
Retrieve Notice of Action (NOA) 09/12/2014
  Inventory as of this Action Requested Previously Approved
01/31/2016 12 Months From Approved
280 0 0
74 0 0
0 0 0
The study seeks to gather feedback on "Act Early" messages and materials from parents/guardians of children age 5 or younger attending the selected six primary care practices recruited for this study (3 in the Baltimore, Maryland (MD)/Washington, DC metropolitan area and 3 in the Atlanta, Georgia (GA) metropolitan area). Focus groups followed by intercept interviews will be used to assess the potential impact or influence of the materials on parents' behavioral intentions regarding "acting early" to address concerns with their child's development.
US Code: 42 USC 301 Name of Law: PHSA
  
None
Not associated with rulemaking
  79 FR 28729 05/19/2014
79 FR 52341 09/03/2014
No
  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 280 0 0 280 0 0
Annual Time Burden (Hours) 74 0 0 74 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
New ICR
$88,263
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.
09/12/2014