Information Collection

Health Communication Message Testing on Tuberculosis

IC 235026 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health Communication Message Testing on Tuberculosis	Form and Instruction
Att 1a_Moderator'sGuide.docx	Other-Moderator's Guide
Recruitment Screener Att 1b_RecruitmentScreener-CLEAN.docx	Form and Instruction
SSB_DTBE-CLEAN.docx Supporting Statement B	IC Document
Att 2a_Email-NoIRBNeeded.pdf IRB Letter	IC Document
Att 3_ThemesandMessages.docx Topics and messages for testing	IC Document
Att 4_EducationalPowerPoint.pdf TB Powerpoint	IC Document
SSA_DTBE-2.28.19-Clean.docx Supporting Statement A	IC Document
PT2 Wrk Att1b_Screener.pdf PT2 Wrk Att1b_Screener	IC Document
PT2 Wrk Att 1a_Moderator.pdf Pt2 Wrk Att1a_Moderator	IC Document
Att 2b_Project-Determination-and-Approval-Form.pdf Research Determination	IC Document

IC Title:

Health Communication Message Testing on Tuberculosis

Agency IC Tracking Number:

0920-0840-19YE

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	none	Recruitment Screener	Att 1b_RecruitmentScreener-CLEAN.docx		Yes	Yes	Fillable Fileable
Other-Moderator's Guide			Att 1a_Moderator'sGuide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,885

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	6,885	6,885
Annual IC Time Burden (Hours)	1,080	1,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement B	SSB_DTBE-CLEAN.docx	02/21/2019
IRB Letter	Att 2a_Email-NoIRBNeeded.pdf	02/21/2019
Topics and messages for testing	Att 3_ThemesandMessages.docx	02/21/2019
TB Powerpoint	Att 4_EducationalPowerPoint.pdf	02/21/2019
Supporting Statement A	SSA_DTBE-2.28.19-Clean.docx	02/28/2019
PT2 Wrk Att1b_Screener	PT2 Wrk Att1b_Screener.pdf	02/28/2019
Pt2 Wrk Att1a_Moderator	PT2 Wrk Att 1a_Moderator.pdf	02/28/2019
Research Determination	Att 2b_Project-Determination-and-Approval-Form.pdf	02/28/2019

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