View Information Collection (IC)
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View Information Collection (IC)

Evaluation of a Latent Tuberculosis Infection (LTBI) Awareness Campaign 0920-22FW
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-22FW Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed Attachment 3a. Appendix B. Consumer Survey Instrument for Exposed.docx Yes Yes Fillable Fileable
Form and Instruction 0920-22FW Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed Attachment 4a. Appendix C. Consumer Survey Instrument for Unexposed.docx Yes Yes Fillable Fileable
Form and Instruction 0920-22FW Attachment 5. Appendix D. HCP Survey Instrument for Exposed Attachment 5. Appendix D. HCP Survey Instrument for Exposed.docx Yes Yes Fillable Fileable
Form and Instruction 0920-22FW Attachment 6. Appendix E. HCP Survey Instrument for Unexposed Attachment 6. Appendix E. HCP Survey Instrument for Unexposed.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

250 0
   
Individuals or Households
 
   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 250 0 250 0 0 0
Annual IC Time Burden (Hours) 62 0 62 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 1. DTE Evaluation Protocol Attachment 1. DTE Evaluation Protocol.docx 06/06/2022
Attachment 2. Appendix A. Campaign materials Attachment 2. Appendix A. Campaign materials.docx 06/06/2022
Attachment 3b. Vietnamese_Appendix B. Consumer Survey Instrument for Exposed Attachment 3b. Vietnamese_Appendix B. Consumer Survey Instrument for Exposed.docx 06/06/2022
Attachment 4b. Vietnamese_Appendix C. Consumer Survey Instrument for Unexposed Attachment 4b. Vietnamese_Appendix C. Consumer Survey Instrument for Unexposed.docx 06/06/2022
Attachment 7a. Appendix F. Consumer FLYER to search for more participants in LA and Seattle Attachment 7a. Appendix F. Consumer FLYER to search for more participants in LA and Seattle.docx 06/06/2022
Attachment 7b. Vietnamese_Appendix F. Consumer FLYER to search for more participants in LA and Seattle Attachment 7b. Vietnamese_Appendix F. Consumer FLYER to search for more participants in LA and Seattle.docx 06/06/2022
Attachment 8a. Appendix G. Consumer Invitation to Participate Attachment 8a. Appendix G. Consumer Invitation to Participate.docx 06/06/2022
Attachment 8b. Vietnamese_Appendix G. Consumer Invitation to Participate Attachment 8b. Vietnamese_Appendix G. Consumer Invitation to Participate.docx 06/06/2022
Attachment 9. Appendix H. HCP Invitation to Participate Attachment 9. Appendix H. HCP Invitation to Participate.docx 06/06/2022
Attachment 10a. Appendix I. Consumer Informed Consent Form Attachment 10a. Appendix I. Consumer Informed Consent Form.docx 06/06/2022
Attachment 10b. Vietnamese_Appendix I. Consumer Informed Consent Form Attachment 10b. Vietnamese_Appendix I. Consumer Informed Consent Form.docx 06/06/2022
Attachment 11. Appendix J. HCP Informed Consent Form Attachment 11. Appendix J. HCP Informed Consent Form.docx 06/06/2022
Attachment 12a. Appendix K. Eligibility Message Attachment 12a. Appendix K. Eligibility Message.docx 06/06/2022
Attachment 12b. Vietnamese_Appendix K. Eligibility Message Attachment 12b. Vietnamese_Appendix K. Eligibility Message.docx 06/06/2022
Attachment 13a. Appendix L. Ineligibility Message Attachment 13a. Appendix L. Ineligibility Message.docx 06/06/2022
Attachment 13b. Vietnamese_Appendix L. Ineligibility Message Attachment 13b. Vietnamese_Appendix L. Ineligibility Message.docx 06/06/2022
Attachment 14a. Appendix M. Consumer Reminder Email to Take the Survey Attachment 14a. Appendix M. Consumer Reminder Email to Take the Survey.docx 06/06/2022
Attachment 14b. Vietnamese_Appendix M. Consumer Reminder Email to Take the Survey Attachment 14b. Vietnamese_Appendix M. Consumer Reminder Email to Take the Survey.docx 06/06/2022
Attachment 15. Appendix N. HCP Reminder Email to Take the Survey Attachment 15. Appendix N. HCP Reminder Email to Take the Survey.docx 06/06/2022
HMTSExpeditedReviewForm HMTSExpeditedReviewForm.pdf 06/06/2022
ProjectDetermination ProjectDetermination.docx 06/06/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.