Information Collection

Health Communications Testing for Latent Tuberculosis Infections Campaign

IC 242449 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-20PT Health Communications Testing for Latent Tuberculosis Infections Campaign	Form and Instruction
0920-20PT Recruitment Screener_Consumer 1a_Recruitment Screener_Consumer_Revised Final_050520.docx	Form and Instruction
0920-20PT Recruitment Screener_Nurse-NP-PA 1b_Recruitment Screener_Nurse-NP-PA_Revised Final_050520.docx	Form and Instruction
0920-20PT Recruitment Screener_Physician 1b_Recruitment Screener_Physician_Revised Final_050520.docx	Form and Instruction
0920-20PT Moderator Guide-IDI_Physician 3c_Moderator Guide-IDI_Physician_Final_020420.docx	Form and Instruction
0920-20PT Moderator Guide-FG_Nurse-NP-PA 3b_Moderator Guide-FG_Nurse-NP-PA_Revised Final_050620.docx	Form and Instruction
0920-20PT Moderator Guide-FG_Consumer 3a_Moderator Guide-FG_Consumer_Revised Final_050620.docx	Form and Instruction
0920-20PT Consent Form_Consumer 2a_Consent Form_Consumer_Final_050520.docx	Form
0920-20PT Consent Form_Nurse-NP-PA 2b_Consent Form_Nurse-NP-PA_Revised Final_050520.docx	Form
0920-20PT Consent Form_Physician 2c_Consent Form_Physician_Revised Final_050520.docx	Form
LTBI Campaign Message Testing project-summary and determination.pdf LTBI Campaign Message Testing project-summary and determination	IC Document
4d_Messages for Testing_Provider_Revised Final_050520.docx Messages for Testing_Provider	IC Document
4c_Messages for Testing_Consumer_Revised Final_050520.docx Messages for Testing_Consumer	IC Document
4b_Level Setting Activity_Provider_Revised Final_050620.docx Level Setting Activity_Provider	IC Document
4a_Level Setting Activity_Consumer_Revised Final_050620.docx Level Setting Activity_Consumer	IC Document
Supporting Statement A_11May20.docx SSA	IC Document
Supporting Statement B 11May20.docx SSB	IC Document
HMTSExpeditedReviewForm_Focus Groups 11May20.pdf HMTS Expedited Review Form_Focus Groups	IC Document
HMTSExpeditedReviewForm_Interviews 11May20.pdf HMTS Expedited Review Form_Interviews	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Health Communications Testing for Latent Tuberculosis Infections Campaign

Agency IC Tracking Number:

0920-20PT

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20PT	Recruitment Screener_Consumer	1a_Recruitment Screener_Consumer_Revised Final_050520.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PT	Recruitment Screener_Nurse-NP-PA	1b_Recruitment Screener_Nurse-NP-PA_Revised Final_050520.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PT	Moderator Guide-IDI_Physician	3c_Moderator Guide-IDI_Physician_Final_020420.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PT	Moderator Guide-FG_Nurse-NP-PA	3b_Moderator Guide-FG_Nurse-NP-PA_Revised Final_050620.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PT	Moderator Guide-FG_Consumer	3a_Moderator Guide-FG_Consumer_Revised Final_050620.docx	Yes	Yes	Fillable Fileable
Form	0920-20PT	Consent Form_Consumer	2a_Consent Form_Consumer_Final_050520.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20PT	Recruitment Screener_Physician	1b_Recruitment Screener_Physician_Revised Final_050520.docx	Yes	Yes	Fillable Fileable
Form	0920-20PT	Consent Form_Nurse-NP-PA	2b_Consent Form_Nurse-NP-PA_Revised Final_050520.docx	Yes	Yes	Fillable Fileable
Form	0920-20PT	Consent Form_Physician	2c_Consent Form_Physician_Revised Final_050520.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,488

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,488	1,488
Annual IC Time Burden (Hours)	355	355
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LTBI Campaign Message Testing project-summary and determination	LTBI Campaign Message Testing project-summary and determination.pdf	06/26/2020
Messages for Testing_Provider	4d_Messages for Testing_Provider_Revised Final_050520.docx	06/26/2020
Messages for Testing_Consumer	4c_Messages for Testing_Consumer_Revised Final_050520.docx	06/26/2020
Level Setting Activity_Provider	4b_Level Setting Activity_Provider_Revised Final_050620.docx	06/26/2020
Level Setting Activity_Consumer	4a_Level Setting Activity_Consumer_Revised Final_050620.docx	06/26/2020
SSA	Supporting Statement A_11May20.docx	06/26/2020
SSB	Supporting Statement B 11May20.docx	06/26/2020
HMTS Expedited Review Form_Focus Groups	HMTSExpeditedReviewForm_Focus Groups 11May20.pdf	06/26/2020
HMTS Expedited Review Form_Interviews	HMTSExpeditedReviewForm_Interviews 11May20.pdf	06/26/2020

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