Information Collection

Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults

IC 238568 under ICR 201806-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults	Form and Instruction
Screener and Focus Group Invitation Attch2_HMTS_Sceener & Invitation_FocusGroups 2019.docx	Form and Instruction
Focus Group Moderators Guide Attch3_HMTS_Moderator Discussion Guide_Focus Groups 2019.docx	Form and Instruction
HMTS Expedited Review Form HepC Message Testing_11.18.19.pdf HMTS Template with Project Overview and Burden	IC Document
Attch1_HMTS_Background Information.docx Project Description (Narrative Format)	IC Document
Attch4_HMTS_Consent Form.docx Consent Form	IC Document
Attach5_HepatitisC Campaign Storyboards to Test.pdf Testing Item: Storyboards for PSA Development	IC Document
Attach6_Feel Healthy Print Concept to Test.pdf Testing Item (print concept): Feel Healthy	IC Document
Attach7_Facts Print Concept to Test.pdf Testing Item (print concept): 3 Facts about Hepatitis	IC Document
Attach8_Faces Print Concept to Test.pdf Testing Item (print concept): Faces of "We Got Tested"	IC Document
Attach9_People Map Print Concept to Test.pdf Testing Item (print concept): Map with Faces	IC Document

IC Title:

Testing Health Communication Messages to Promote Hepatitis C Testing among U.S. Adults

Agency IC Tracking Number:

0920-20CH

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
Form and Instruction	n/a	Screener and Focus Group Invitation	Attch2_HMTS_Sceener & Invitation_FocusGroups 2019.docx		No		Fillable Fileable
Form and Instruction	n/a	Focus Group Moderators Guide	Attch3_HMTS_Moderator Discussion Guide_Focus Groups 2019.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 656

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	656	656
Annual IC Time Burden (Hours)	579	579
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Template with Project Overview and Burden	HMTS Expedited Review Form HepC Message Testing_11.18.19.pdf	12/12/2019
Project Description (Narrative Format)	Attch1_HMTS_Background Information.docx	12/12/2019
Consent Form	Attch4_HMTS_Consent Form.docx	12/12/2019
Testing Item: Storyboards for PSA Development	Attach5_HepatitisC Campaign Storyboards to Test.pdf	12/12/2019
Testing Item (print concept): Feel Healthy	Attach6_Feel Healthy Print Concept to Test.pdf	12/12/2019
Testing Item (print concept): 3 Facts about Hepatitis	Attach7_Facts Print Concept to Test.pdf	12/12/2019
Testing Item (print concept): Faces of "We Got Tested"	Attach8_Faces Print Concept to Test.pdf	12/12/2019
Testing Item (print concept): Map with Faces	Attach9_People Map Print Concept to Test.pdf	12/12/2019

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