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

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.