Information Collection

Evaluation of Adapted Health Education Materials for LEP Spanish-Speakers and Indigenous Migrants

IC 206924 under ICR 201203-0920-007 · OMB 0920-0932.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0932 can be found here:

Documents and Forms

Document Name Document Type
Attachment C- Indigenous TB Discussion Guide.docx Other-Focus Group Script
Attachment B-LEP TB QF Discussion Guide.docx Other-Focus Group Script
Attachment D- LEP Flu Discussion Guide.docx Other-Focus Group Script
Attachment E-Indigenous Flu Discussion Guide.docx Other-Focus Group Script
Screener Attachment F- Participant Screener.docx Form
Attachment A-Materials for Adaptation.pdf Materials for Adaptation IC Document
Attachment G-IRB Determination.pdf IRB Determination IC Document
Attachment H-Participant Information Sheet.docx Participant Information Sheet IC Document
ECT Supporting Statement A.DOCX Supporting Statement Part A IC Document
ECT Supporting Statement B.DOCX Supporting Statement Part B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of Adapted Health Education Materials for LEP Spanish-Speakers and Indigenous Migrants	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Focus Group Script			Attachment C- Indigenous TB Discussion Guide.docx	Yes	No	Fillable Printable
Other-Focus Group Script			Attachment B-LEP TB QF Discussion Guide.docx	Yes	No	Fillable Printable
Other-Focus Group Script			Attachment D- LEP Flu Discussion Guide.docx	Yes	No	Fillable Printable
Other-Focus Group Script			Attachment E-Indigenous Flu Discussion Guide.docx	Yes	No	Fillable Printable
Form	none	Screener	Attachment F- Participant Screener.docx	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 480	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	480	0	0	0	0	0
Annual IC Time Burden (Hours)	373	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Materials for Adaptation	Attachment A-Materials for Adaptation.pdf	05/14/2013
IRB Determination	Attachment G-IRB Determination.pdf	05/14/2013
Participant Information Sheet	Attachment H-Participant Information Sheet.docx	05/14/2013
Supporting Statement Part A	ECT Supporting Statement A.DOCX	05/15/2013
Supporting Statement Part B	ECT Supporting Statement B.DOCX	05/15/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.