Information Collection

Evaluation of an Education Intervention for Immigration Applicants with B1 or B2 Tuberculosis Classificati

IC 239665 under ICR 201803-0920-013 · OMB 0920-0932.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evaluation of an Education Intervention for Immigration Applicants with B1 or B2 Tuberculosis Classificati	Form
B1 Pretest Attachment 4-Data Collection Instrument B1 Pre-Test .docx	Form
B1 Pretest - Spanish Anexo 4- Instrumento preliminar de recolección de datos B1.docx	Form
B1 Post-test Attachment 5-Data Collection Instrument B1 Post-Test for Comparison and Program Groups.docx	Form
B1 Post-test - Spanish Anexo 5- Instrumento de recolección de datos post- prueba para grupos de comparación y programas B1.docx	Form
B2 Pretest Attachment 6- Data Collection Instrument B2 Pre-Test.docx	Form
B2 Pretest - Spanish Anexo 6- Instrumento preliminar de recolección de datos B2.docx	Form
B2 Post-test Attachment 7- Data Collection Instrument B2 Post-Test for Comparison and Program Groups.docx	Form
B2 Post-test - Spanish Anexo 7- Instrumento de recolección de datos post- prueba para grupos de comparación y programas B2.docx	Form
B1 Screener Attachment 9- B1 Applicant Screener.docx	Form
B1 Screener - Spanish Anexo 9- Selección de aplicantes B1.docx	Form
B2 Screener Attachment 11- B2 Applicant Screener.docx	Form
B2 Screener Anexo 11- Selección de aplicantes B2.docx	Form
Statement A .docx Supporting Statement A	IC Document
Statement B.docx Supporting Statement B	IC Document
Attachment 1- B1 Applicant Consent Script.docx B1 Consent	IC Document
Anexo 1- Consentimiento escrito para aplicantes B1.docx B1 Consent - Spanish	IC Document
Attachment 2- B2 Applicant Consent Script.docx B2 Consent	IC Document
Anexo 2- Consentimiento escrito para aplicantes B2.docx B2 Consent - Spanish	IC Document
Attachment 3- Non-Research Determination.pdf Non-research determination	IC Document
Attachment 8- B1 Applicant Recruitment Script .docx B1 Recruitment	IC Document
Anexo 8- Guion de reclutamiento para aplicantes B1.docx B1 Recruitment - Spanish	IC Document
Attachment 10- B2 Applicant Recruitment Script.docx B2 Recruitment	IC Document
Anexo 10- Guion de reclutamiento para Aplicantes B2.docx B2 Recruitment - Spanish	IC Document
Attachment 12- B1 Photo Novella.docx B1 Photo Novella	IC Document
Attachment 12- B1 Photo Novella_Spanish.docx B1 Photo Novella - Spanish	IC Document
Attachment 13- B2 Photo Novella.docx B2 Photo Novella	IC Document
Attachment 13- B2 Photo Novella_Spanish.docx B2 Photo Novella - Spanish	IC Document
Attachment 14- B1B2 Educational Video.docx Educational video	IC Document
Attachment 14- B1B2 Educational Video_Spanish.docx Educational video- Spanish	IC Document
Attachment 15- Directory.docx Directory	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Evaluation of an Education Intervention for Immigration Applicants with B1 or B2 Tuberculosis Classificati

Agency IC Tracking Number:

0920-0932-20EV

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	Available Electronically?	Electronic Capability
Form	none	B1 Pretest	Attachment 4-Data Collection Instrument B1 Pre-Test .docx	No	Paper Only
Form	none	B1 Pretest - Spanish	Anexo 4- Instrumento preliminar de recolecciÃ³n de datos B1.docx	No	Paper Only
Form	none	B1 Post-test	Attachment 5-Data Collection Instrument B1 Post-Test for Comparison and Program Groups.docx	No	Paper Only
Form	none	B1 Post-test - Spanish	Anexo 5- Instrumento de recolecciÃ³n de datos post- prueba para grupos de comparaciÃ³n y programas B1.docx	No	Paper Only
Form	none	B2 Pretest	Attachment 6- Data Collection Instrument B2 Pre-Test.docx	No	Paper Only
Form	none	B2 Pretest - Spanish	Anexo 6- Instrumento preliminar de recolecciÃ³n de datos B2.docx	No	Paper Only
Form	none	B2 Post-test	Attachment 7- Data Collection Instrument B2 Post-Test for Comparison and Program Groups.docx	No	Paper Only
Form	none	B2 Post-test - Spanish	Anexo 7- Instrumento de recolecciÃ³n de datos post- prueba para grupos de comparaciÃ³n y programas B2.docx	No	Paper Only
Form	none	B1 Screener	Attachment 9- B1 Applicant Screener.docx	No	Paper Only
Form	none	B1 Screener - Spanish	Anexo 9- SelecciÃ³n de aplicantes B1.docx	No	Paper Only
Form	none	B2 Screener	Attachment 11- B2 Applicant Screener.docx	No	Paper Only
Form	none	B2 Screener	Anexo 11- SelecciÃ³n de aplicantes B2.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,164

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	1,164	1,164
Annual IC Time Burden (Hours)	236	236
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Statement A .docx	01/30/2020
Supporting Statement B	Statement B.docx	01/30/2020
B1 Consent	Attachment 1- B1 Applicant Consent Script.docx	01/30/2020
B1 Consent - Spanish	Anexo 1- Consentimiento escrito para aplicantes B1.docx	01/30/2020
B2 Consent	Attachment 2- B2 Applicant Consent Script.docx	01/30/2020
B2 Consent - Spanish	Anexo 2- Consentimiento escrito para aplicantes B2.docx	01/30/2020
Non-research determination	Attachment 3- Non-Research Determination.pdf	01/30/2020
B1 Recruitment	Attachment 8- B1 Applicant Recruitment Script .docx	01/30/2020
B1 Recruitment - Spanish	Anexo 8- Guion de reclutamiento para aplicantes B1.docx	01/30/2020
B2 Recruitment	Attachment 10- B2 Applicant Recruitment Script.docx	01/30/2020
B2 Recruitment - Spanish	Anexo 10- Guion de reclutamiento para Aplicantes B2.docx	01/30/2020
B1 Photo Novella	Attachment 12- B1 Photo Novella.docx	01/30/2020
B1 Photo Novella - Spanish	Attachment 12- B1 Photo Novella_Spanish.docx	01/30/2020
B2 Photo Novella	Attachment 13- B2 Photo Novella.docx	01/30/2020
B2 Photo Novella - Spanish	Attachment 13- B2 Photo Novella_Spanish.docx	01/30/2020
Educational video	Attachment 14- B1B2 Educational Video.docx	01/30/2020
Educational video- Spanish	Attachment 14- B1B2 Educational Video_Spanish.docx	01/30/2020
Directory	Attachment 15- Directory.docx	01/30/2020

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