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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.