My Family Health Portrait Usability Study

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 My Family Health Portrait Usability Study Form and Instruction
0920-1050 Pre-Study Meeting Attachment 3_Pre study meeting.docx Form and Instruction
0920-1050 Week 1 Task Questions Attachment 4a_Week 1_Task_Questions.docx Form and Instruction
0920-1050 Weeks 2-3 Task Questions Attachment 5a_Weeks 2_3 task questions.docx Form and Instruction
0920-1050 Weeks 4-5 Task Questions Attachment 6a_Weeks 4_5 task questions.docx Form and Instruction
0920-1050 Post-Study Interview Attachment 7_Post study interview.docx Form and Instruction
0920-1050 Recruitment Screener Attachment 1_Recruitment Screener_REVISED.docx Form and Instruction
Attachment 4b_Week 1 emails (initial and reminder).docx Week 1 Email Reminder IC Document
Attachment 5b_Weeks 2_3 emails (weekly and reminder).docx Weeks 2-3 Email Reminder IC Document
Attachment 6b_Weeks 4_5 emails (weekly and reminder).docx Weeks 4-5 Email Reminder IC Document
Appendix_A_MFHP Study_Overview.docx MFHP Study Overview IC Document
Appendix_B_MFHP_Screener_Details.docx MFHP Screener Details IC Document
Attachment 1a_Study Design Graphic.docx MFHP Study Design Graphic IC Document
Attachment 2_Consent form.docx MFHP Consent Form IC Document
GenIC Template_MFHP Usability Study.docx 0920-1050 GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	My Family Health Portrait Usability Study	Agency IC Tracking Number:	0920-1050-24GE

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 and Instruction	0920-1050	Pre-Study Meeting	Attachment 3_Pre study meeting.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Week 1 Task Questions	Attachment 4a_Week 1_Task_Questions.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Weeks 2-3 Task Questions	Attachment 5a_Weeks 2_3 task questions.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Weeks 4-5 Task Questions	Attachment 6a_Weeks 4_5 task questions.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Post-Study Interview	Attachment 7_Post study interview.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Recruitment Screener	Attachment 1_Recruitment Screener_REVISED.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 160	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	137	137
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Week 1 Email Reminder	Attachment 4b_Week 1 emails (initial and reminder).docx	06/05/2024
Weeks 2-3 Email Reminder	Attachment 5b_Weeks 2_3 emails (weekly and reminder).docx	06/05/2024
Weeks 4-5 Email Reminder	Attachment 6b_Weeks 4_5 emails (weekly and reminder).docx	06/05/2024
MFHP Study Overview	Appendix_A_MFHP Study_Overview.docx	06/05/2024
MFHP Screener Details	Appendix_B_MFHP_Screener_Details.docx	06/05/2024
MFHP Study Design Graphic	Attachment 1a_Study Design Graphic.docx	06/05/2024
MFHP Consent Form	Attachment 2_Consent form.docx	06/05/2024
0920-1050 GenIC Request Template	GenIC Template_MFHP Usability Study.docx	06/20/2024

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