My Mobility Product Testing Activities

[OADC] CDC Usability and Digital Content Testing

OMB: 0920-1050

IC ID: 255311

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Other-WORD
Form and Instruction
IC Document
IC Document
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IC Document
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IC Document
IC Document
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IC Document
Information Collection (IC) Details

View Information Collection (IC)

My Mobility Product Testing Activities 0920-1050-22IH
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1050 Participant Screener (English Groups) AttM_ParticipantScreeners.docx No   Fillable Fileable
Instruction AttN_PreInterviewGuides.docx No   Paper Only
Instruction AttP_ModeratorGuides.docx No   Paper Only
Other-WORD AttO_ConsentForms.docx No   Fillable Fileable Signable

Health Consumer Health and Safety

 

320 0
   
Individuals or Households
 
   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 320 0 0 0 0 320
Annual IC Time Burden (Hours) 108 0 0 0 0 108
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050) 1050 Request_MyMobility Product Testing_8.9.22.docx 08/16/2022
My Mobility Plan (English) AttA_MyMobility_Plan_English.pdf 08/16/2022
My Mobility Plan Spanish AttB_MyMobility_Plan_Spanish.pdf 08/16/2022
My Mobility Plan_Tribal AttC_MyMobility_Plan_Tribal.pdf 08/16/2022
Medicine Fact Sheet (English) AttD_Medicine_Fact_Sheet_English.pdf 08/16/2022
Medicine Fact Sheet (Spanish) AttE_Medicine_Fact_Sheet_Spanish.pdf 08/16/2022
Medicine Fact Sheet (Tribal) AttF_Medicine_Fact_Sheet_Tribal.pdf 08/16/2022
MyMedications List (English) AttG_MyMedications_List_English.pdf 08/16/2022
MyMedications List (Spanish AttH_MyMedications_List_Spanish.pdf 08/16/2022
MyMedications LIst (Tribal) AttI_MyMedications_List_Tribal.pdf 08/16/2022
MyMedications Action Plan (English) AttJ_MyMedications_Action_Plan_English.pdf 08/16/2022
MyMedications Action Plan (Spanish) AttK_MyMedications_Action_Plan_Spanish.pdf 08/16/2022
MyMedications Action Plan (Tribal) AttL_MyMedications_Action_Plan_Tribal.pdf 08/16/2022
My Mobility PIA My Mobility _PIA.pdf 08/16/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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