Information Collection

Pretesting Health Communication Resources With Immigration Applicants With B1 Or B2 Tuberculosis Classifications

IC 252510 under ICR 202108-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0572 Educational Video (script) PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B1 Your Health and Moving to the United States PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B2 Moving to the United States and Your Health PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B1 Applicant Intercept Interview Guide PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B1 Applicant Consent Script (Chest X-Ray) PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B2 Applicant Consent Script (Child's Blood Test) PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 Clinic Staff In-depth Interview Consent Script PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 In-depth Interview Guide PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B1 Client Recruitment Script PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B2 Client Recruitment Script PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B1 Client Screener PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
Form 0920-0572 B2 Client Screener PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS	Form
0920-0572 Educational Video (script) Att 01_SPAN_ENG B1B2 Ed Video Script_FINAL_11122021.docx	Form
0920-0572 B1 Your Health and Moving to the United States Att 02_B1 Photo Novella Storyboard_FINAL_11122021.docx	Form
0920-0572 B2 Moving to the United States and Your Health Att 03_B2 Photo Novella Storyboard_FINAL_11122021.docx	Form
0920-0572 B1 Applicant Intercept Interview Guide Att 05_B1 B2 Applicant Intercept Interview Guide.docx	Form
0920-0572 B1 Applicant Consent Script (Chest X-Ray) Att 06_B1 Client Consent Script.docx	Form
0920-0572 B2 Applicant Consent Script (Child's Blood Test) Att 07_B2 Client Consent Script.docx	Form
0920-0572 Clinic Staff In-depth Interview Consent Script Att 08_Clinical Staff Consent Script_v2.docx	Form
0920-0572 In-depth Interview Guide Att 09_Clinic Staff Individual Interview Guide_v2.docx	Form
0920-0572 B1 Client Recruitment Script Att 10_B1 Client Recruitment Script.docx	Form
0920-0572 B2 Client Recruitment Script Att 11_B2 Client Recruitment Script.docx	Form
0920-0572 B1 Client Screener Att 12_B1 Client Screener.docx	Form
0920-0572 B2 Client Screener Att 13_B2 Client Screener.docx	Form
Att 04_TB Care Finder Webform Screen Shots.docx TB Care Finder Webform Screenshots	IC Document
B1 B2 Health Message Testing Protocol_02032022.docx Applicants with B1 and B2 Tuberculosis Classifications	IC Document
HMTS Expedited Review Form_B1B2 Health Message Testing.pdf HTMS Review Form	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PRETESTING HEALTH COMMUNICATION RESOURCES WITH IMMIGRATION APPLICANTS WITH B1 OR B2 TUBERCULOSIS CLASSIFICATIONS

Agency IC Tracking Number:

0920-0572-22EA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	No	Paper Only
Form	0920-0572	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: 197

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	197	197
Annual IC Time Burden (Hours)	102	102
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TB Care Finder Webform Screenshots		04/01/2022
Applicants with B1 and B2 Tuberculosis Classifications		04/01/2022
HTMS Review Form		04/01/2022

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

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