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View Information Collection (IC)

Health Communications Testing for Latent Tuberculosis Infections Campaign 0920-20PT
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-20PT Recruitment Screener_Consumer 1a_Recruitment Screener_Consumer_Revised Final_050520.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20PT Recruitment Screener_Nurse-NP-PA 1b_Recruitment Screener_Nurse-NP-PA_Revised Final_050520.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20PT Recruitment Screener_Physician 1b_Recruitment Screener_Physician_Revised Final_050520.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20PT Moderator Guide-IDI_Physician 3c_Moderator Guide-IDI_Physician_Final_020420.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20PT Moderator Guide-FG_Nurse-NP-PA 3b_Moderator Guide-FG_Nurse-NP-PA_Revised Final_050620.docx Yes Yes Fillable Fileable
Form and Instruction 0920-20PT Moderator Guide-FG_Consumer 3a_Moderator Guide-FG_Consumer_Revised Final_050620.docx Yes Yes Fillable Fileable
Form 0920-20PT Consent Form_Consumer 2a_Consent Form_Consumer_Final_050520.docx Yes Yes Fillable Fileable
Form 0920-20PT Consent Form_Nurse-NP-PA 2b_Consent Form_Nurse-NP-PA_Revised Final_050520.docx Yes Yes Fillable Fileable
Form 0920-20PT Consent Form_Physician 2c_Consent Form_Physician_Revised Final_050520.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

1,488 0
   
Individuals or Households
 
   100 %

  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 1,488 0 1,488 0 0 0
Annual IC Time Burden (Hours) 355 0 355 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
LTBI Campaign Message Testing project-summary and determination LTBI Campaign Message Testing project-summary and determination.pdf 06/26/2020
Messages for Testing_Provider 4d_Messages for Testing_Provider_Revised Final_050520.docx 06/26/2020
Messages for Testing_Consumer 4c_Messages for Testing_Consumer_Revised Final_050520.docx 06/26/2020
Level Setting Activity_Provider 4b_Level Setting Activity_Provider_Revised Final_050620.docx 06/26/2020
Level Setting Activity_Consumer 4a_Level Setting Activity_Consumer_Revised Final_050620.docx 06/26/2020
SSA Supporting Statement A_11May20.docx 06/26/2020
SSB Supporting Statement B 11May20.docx 06/26/2020
HMTS Expedited Review Form_Focus Groups HMTSExpeditedReviewForm_Focus Groups 11May20.pdf 06/26/2020
HMTS Expedited Review Form_Interviews HMTSExpeditedReviewForm_Interviews 11May20.pdf 06/26/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.