Information Collection

Research and Message Pre-testing among Baby Boomers - Hepatitis C

IC 216077 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Att2 HCV Focus Group Discussion Guide DVH.docx Instruction
Screener Att1 HCV Screener DVH.docx Form
RequestTemplate_2015 ScreenerFocus Group.docx Request for Approval - screener IC Document
RequestTemplate_2015 Focus Groups Discussion.docx Request for Approval - Focus Group IC Document
HCV Supporting Statements.docx Supporting Statements IC Document
KMH Phase III Creative for OMB.pdf Hepatitis C Messages IC Document
Service DeliveryChecklist_2015HCV-Screener.docx Clearance Checklist IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Research and Message Pre-testing among Baby Boomers - Hepatitis C	Agency IC Tracking Number:	15AAA

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
Instruction			Att2 HCV Focus Group Discussion Guide DVH.docx		Yes	No	Paper Only
Form	none	Screener	Att1 HCV Screener DVH.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 491	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	491	491
Annual IC Time Burden (Hours)	478	478
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval - screener	RequestTemplate_2015 ScreenerFocus Group.docx	04/13/2015
Request for Approval - Focus Group	RequestTemplate_2015 Focus Groups Discussion.docx	04/13/2015
Supporting Statements	HCV Supporting Statements.docx	04/13/2015
Hepatitis C Messages	KMH Phase III Creative for OMB.pdf	04/13/2015
Clearance Checklist	Service DeliveryChecklist_2015HCV-Screener.docx	04/13/2015

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