View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Hispanic, Black and Pacific Islander Perspectives on COVID-19 Outreach Strategies and Patient Centered Outcomes (HeAR US))
Agency IC Tracking Number:
OC
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
Other-Focus Group Questionnaire (ENGLISH)
ENGLISH_Focus Group Check In Questionnaire_final.docx
Yes
Yes
Fillable Fileable
Other-Focus Group Questionnaire (SPANISH)
SPANISH_Focus Group Check In Questionnaire_final.docx
Yes
Yes
Fillable Fileable
Other-Focus Group Moderator Interview Guide (ENGLISH)
ENGLISH_Focus Group Moderator Interview Guide_final.docx
No
Printable Only
Other-Focus Group Moderator Interview Guide (SPANISH)
SPANISH_Focus Group Moderator Interview Guide_final.docx
No
Printable Only
Other-Recruitment Script Phone (ENGLISH)
ENGLISH_Recruitment Tools (phone script)_final.docx
No
Printable Only
Other-Recruitment Script Phone (SPANISH)
SPANISH_Recruitment Tools (phone script)_final.docx
No
Printable Only
Other-Recruitment Script Email (ENGLISH)
ENGLISH_Recruitment Tools (email script)_final.docx
Yes
No
Printable Only
Other-Recruitment Script Email (SPANISH)
SPANISH_Recruitment Tools (email script)_final.docx
Yes
No
Printable Only
Other-Informed Consent (ENGLISH)
ENGLISH_HeAR US Informed Consent_final.docx
Yes
No
Printable Only
Other-Informed Consent (SPANISH)
SPANISH_HeAR US Informed Consent_final.docx
Yes
No
Printable Only
Other-Study Flyer (ENGLISH)
ENGLISH_HeAR US Study Flyer_final.pptx
No
Printable Only
Other-Study Flyer (SPANISH)
SPANISH_HeAR US Study Flyer_final.pptx
No
Printable Only
Other-FDA graphics for use with Moderator Guide (ENGLISH)
ENGLISH_FDA graphics for misinformation.docx
Yes
No
Printable Only
Other-FDA graphics for use with Moderator Guide (SPANISH)
SPANISH_FDA graphics for misinformation.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
20 %
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
165
0
165
0
0
0
Annual IC Time Burden (Hours)
248
0
248
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Memo
HeAR US 0497 OMB Memo final.docx
12/08/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
An official website of the United States government
The .gov means it's official.
The site is secure.
