Information Collection

Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program

IC 205934 under ICR 201501-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0572 Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program Form and Instruction
0920-0572 Planes, Trains and Autop Appendix B3 Response Form Appendix B3 Response Form.docx Form and Instruction
0920-0572 Planes, Trains and Auto Appendix B Instructions for Inte Appendix B Instructions for Interviewers 1.docx Form and Instruction
0920-0572 Plane, Trains and Auto Appendix B 1 Interview 1 Appendix B1 Interview 1.docx Form and Instruction
0920-0572 Planes, Trains and Autop Appendix B2 Interview Cards 1 Appendix B2 Interview 1 Cards.pptx Form and Instruction
0920-0572 Planes, Trains Auto Appendix B4 Participant Inform Appendix B4 Participant Information Sheet.docx Form and Instruction
0920-0572 Plane, Trains and Auto Appendix 5 Question 1 Rationale Appendix B5 Question 1 Rationale_v2.docx Form and Instruction
0920-0572 Plane, Train Auto Appendix C Handheld Screenshots Appendix C Handheld Screenshots.docx Form and Instruction
0920-0572 Testing of brand Appendix A1-Screener-Consumers 010 Appendix A1-Screener-Consumers 010713.docx Form and Instruction
0920-0572 Testing of brand concepts Appendix A2-Screener-HCP Appendix A2-Screener-HCP 010713.docx Form and Instruction
0920-0572 Testing of brand concepts Appendix B1-Consent form Appendix B1-Consent form-Consumer FGs 122812.docx Form and Instruction
0920-0572 Testing of brand concepts Appendix B2-Consent form- Appendix B2-Consent form-HCP Triads 122812.docx Form and Instruction
0920-0572 Testing of Brand Appendix C1-Moderators Guide- Consumers Appendix C1-Moderators Guide- Consumers FG 020613.docx Form and Instruction
0920-0572 Testing of brands Appendix C2-Moderators Guide- HCP tria Appendix C2-Moderators Guide- HCP triads 020613.docx Form and Instruction
0920-0572 Testing of brand Appendix D2-NDPP Branding Message Testi Appendix D2-NDPP Branding Message Testing Supplement 010713.docx Form and Instruction
HMTSExpeditedReviewForm Interview 1.pdf Planes, Trains, Auto HMTSExpeditedReviewForm Interview 1 IC Document
HMTSExpeditedReviewForm- NPPP branding and message testing 011113.pdf NPPP Brand and Message Testing Expedited Review Form IC Document
List of Appendices.docx Testing of brands list of Appendices IC Document
Appendix A.docx Planes, Trains and auto Appendix A IC Document
Appendix A1 IRB Approval.docx Planes, Trains Auto Appendix A1 IRB Approval IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Planes,Trains and Auto-Mobility: Increase Walking in the Atl Hartsfield-Jackson Arprt And Testing of brand concepts, msgs and material CDC National Diabetes Prevntion Program	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572	Planes, Trains and Autop Appendix B3 Response Form	Appendix B3 Response Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of Brand Appendix C1-Moderators Guide- Consumers FG	Appendix C1-Moderators Guide- Consumers FG 020613.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Planes, Trains and Auto Appendix B Instructions for Interview	Appendix B Instructions for Interviewers 1.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Plane, Trains and Auto Appendix B 1 Interview 1	Appendix B1 Interview 1.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Planes, Trains and Autop Appendix B2 Interview Cards 1	Appendix B2 Interview 1 Cards.pptx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Planes, Trains Auto Appendix B4 Participant Inform	Appendix B4 Participant Information Sheet.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Plane, Trains and Auto Appendix 5 Question 1 Rationale	Appendix B5 Question 1 Rationale_v2.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Plane, Train Auto Appendix C Handheld Screenshots	Appendix C Handheld Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brand Appendix A1-Screener-Consumers 010	Appendix A1-Screener-Consumers 010713.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brand concepts Appendix A2-Screener-HCP	Appendix A2-Screener-HCP 010713.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brand concepts Appendix B1-Consent form	Appendix B1-Consent form-Consumer FGs 122812.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brand concepts Appendix B2-Consent form-	Appendix B2-Consent form-HCP Triads 122812.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brands Appendix C2-Moderators Guide- HCP triads	Appendix C2-Moderators Guide- HCP triads 020613.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Testing of brand Appendix D2-NDPP Branding Message Testing Supplement	Appendix D2-NDPP Branding Message Testing Supplement 010713.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: 344	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	344	344
Annual IC Time Burden (Hours)	261	261
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Planes, Trains, Auto HMTSExpeditedReviewForm Interview 1	HMTSExpeditedReviewForm Interview 1.pdf	02/19/2013
NPPP Brand and Message Testing Expedited Review Form	HMTSExpeditedReviewForm- NPPP branding and message testing 011113.pdf	02/21/2013
Testing of brands list of Appendices	List of Appendices.docx	02/21/2013
Planes, Trains and auto Appendix A	Appendix A.docx	02/21/2013
Planes, Trains Auto Appendix A1 IRB Approval	Appendix A1 IRB Approval.docx	02/21/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.