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View Information Collection (IC)

CDC Latent Tuberculosis Infection Campaign: Message and Material Testing with Health Care Providers Who Serve Consumers Born in The Philippines and Vietnam 0920-21DF
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Recruitment Screener for Nurse Practitioners and Physician Assistants ATT 1a_LTBI Screener_NP-PA.docx Yes Yes Fillable Fileable
Form and Instruction n/a Recruitment Screener for Physicians ATT 1b_LTBI Screener_Physician.docx Yes Yes Fillable Fileable
Form and Instruction n/a Guide for Virtual Interview with Nurse Practitioners or Physician Assistants ATT 3a_LTBI Interview_Physician_PA-NP.docx Yes Yes Fillable Fileable
Form and Instruction n/a Guide for Virtual Interview with Physicians ATT 3a_LTBI Interview_Physician_PA-NP.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

40 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 17 0 17 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HMTS Template with Project Overview HMTSExpeditedReviewForm_LTBI_Providers_02112021.pdf 02/19/2021
Supporting Statement Part A HMTS_SSA_LatentTB_Providers_02112021.docx 02/19/2021
Supporting Statement Part B HMTS_SSB_LatentTB_Providers.docx 02/19/2021
Project Information Sheet for Participants ATT 2a_LTBI Information Sheet_HCP_02112021.docx 02/19/2021
TEST ITEM: Campaign Consumer Creative Concepts ATT 4a_LTBI Campaign Consumer Creative.pdf 02/19/2021
TEST ITEM: Campaign Fact Sheet ATT 4b_LTBI Campaign Fact Sheet.pdf 02/19/2021
TEST ITEM (Poster): Guidance for Healthcare Providers ATT 4c_LTBI Campaign Provider Poster.pdf 02/19/2021
TEST ITEM: Busting the Myths Learn the Facts About TB ATT 4d_LTBI Campaign Busting Myths.pdf 02/19/2021
TEST ITEM: Talking with Your Patient about LTBI Conversation Guide ATT 4e_LTBI Campaign Provider Conversation.pdf 02/19/2021
Non-research and PRA Determinations ATT 5a_Non-research and PRA Project Determinations.pdf 02/19/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.