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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Evaluation of an Education Intervention for Immigration Applicants with B1 or B2 Tuberculosis Classificati
Agency IC Tracking Number:
0920-0932-20EV
IC Status:
New
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
none
B1 Pretest
Attachment 4-Data Collection Instrument B1 Pre-Test .docx
No
Paper Only
Form
none
B1 Pretest - Spanish
Anexo 4- Instrumento preliminar de recolección de datos B1.docx
No
Paper Only
Form
none
B1 Post-test
Attachment 5-Data Collection Instrument B1 Post-Test for Comparison and Program Groups.docx
No
Paper Only
Form
none
B1 Post-test - Spanish
Anexo 5- Instrumento de recolección de datos post- prueba para grupos de comparación y programas B1.docx
No
Paper Only
Form
none
B2 Pretest
Attachment 6- Data Collection Instrument B2 Pre-Test.docx
No
Paper Only
Form
none
B2 Pretest - Spanish
Anexo 6- Instrumento preliminar de recolección de datos B2.docx
No
Paper Only
Form
none
B2 Post-test
Attachment 7- Data Collection Instrument B2 Post-Test for Comparison and Program Groups.docx
No
Paper Only
Form
none
B2 Post-test - Spanish
Anexo 7- Instrumento de recolección de datos post- prueba para grupos de comparación y programas B2.docx
No
Paper Only
Form
none
B1 Screener
Attachment 9- B1 Applicant Screener.docx
No
Paper Only
Form
none
B1 Screener - Spanish
Anexo 9- Selección de aplicantes B1.docx
No
Paper Only
Form
none
B2 Screener
Attachment 11- B2 Applicant Screener.docx
No
Paper Only
Form
none
B2 Screener
Anexo 11- Selección de aplicantes B2.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,164
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
1,164
0
1,164
0
0
0
Annual IC Time Burden (Hours)
236
0
236
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
Statement A .docx
01/30/2020
Supporting Statement B
Statement B.docx
01/30/2020
B1 Consent
Attachment 1- B1 Applicant Consent Script.docx
01/30/2020
B1 Consent - Spanish
Anexo 1- Consentimiento escrito para aplicantes B1.docx
01/30/2020
B2 Consent
Attachment 2- B2 Applicant Consent Script.docx
01/30/2020
B2 Consent - Spanish
Anexo 2- Consentimiento escrito para aplicantes B2.docx
01/30/2020
Non-research determination
Attachment 3- Non-Research Determination.pdf
01/30/2020
B1 Recruitment
Attachment 8- B1 Applicant Recruitment Script .docx
01/30/2020
B1 Recruitment - Spanish
Anexo 8- Guion de reclutamiento para aplicantes B1.docx
01/30/2020
B2 Recruitment
Attachment 10- B2 Applicant Recruitment Script.docx
01/30/2020
B2 Recruitment - Spanish
Anexo 10- Guion de reclutamiento para Aplicantes B2.docx
01/30/2020
B1 Photo Novella
Attachment 12- B1 Photo Novella.docx
01/30/2020
B1 Photo Novella - Spanish
Attachment 12- B1 Photo Novella_Spanish.docx
01/30/2020
B2 Photo Novella
Attachment 13- B2 Photo Novella.docx
01/30/2020
B2 Photo Novella - Spanish
Attachment 13- B2 Photo Novella_Spanish.docx
01/30/2020
Educational video
Attachment 14- B1B2 Educational Video.docx
01/30/2020
Educational video- Spanish
Attachment 14- B1B2 Educational Video_Spanish.docx
01/30/2020
Directory
Attachment 15- Directory.docx
01/30/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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