Information Collection

[OADC] Developing and Testing New Infographics for Health Equity

IC 265660 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⚠️ Notice: This information collection may be referencing outdated material.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 General Population Screening Questionnaire [OADC] Developing and Testing New Infographics for Health Equity	Form
Form 0920-0572 Screening Questionnaire [OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction
Form 0920-0572 General Population Quantitative Testing Instrument [OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction
Form 0920-0572 Public Health Professionals Quantitative Testing Instrument [OADC] Developing and Testing New Infographics for Health Equity	Form and Instruction
Form 0920-0572 Qualitative Focus Group Discussion Guide – All Audiences [OADC] Developing and Testing New Infographics for Health Equity	Form
0920-0572 General Population Screening Questionnaire Attachment 2-General Population Screening Questionnaire_v2.docx	Form
0920-0572 Screening Questionnaire Attachment 3-Professional Screening Questionnaire_v2.docx	Form and Instruction
0920-0572 General Population Quantitative Testing Instrument Attachment 5-General Population Quantitative Testing Instrument_v2.docx	Form and Instruction
0920-0572 Public Health Professionals Quantitative Testing Instrum Attachment 6-Public Health Professionals Quantitative Testing Instrument_v2.docx	Form and Instruction
0920-0572 Qualitative Focus Group Discussion Guide – All Audiences Attachment 7-Qualitative Focus Group Discussion Guide_All Audiences.docx	Form
OHE_Health Equity Infographics-HMTS Expedited Review Form.docx HMTS Expedited Review Form	IC Document
Attachment 1-Communications Materials Testing Plan.docx Communications Materials Testing Plan	IC Document
Attachment 4-Professional Recruitment Message Templates.docx Professional Recruitment Message Templates	IC Document
Attachment 8-Health Equity Infographics for Testing.pdf Social Determinants of Health	IC Document
Attachment 9-Quantitative Data Collection Informed Consent Form.docx Informed Consent Form (Online Survey)	IC Document
Attachment 10-Qualitative Data Collection Informed Consent Form.docx Informed Consent Form (Focus Group)	IC Document
Health Equity Infographic Testing Attachment Guide.docx Attachment List	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[OADC] Developing and Testing New Infographics for Health Equity

Agency IC Tracking Number:

0920-0572-24DH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0572	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	Yes	Yes	Fillable Fileable
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: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Expedited Review Form		02/28/2024
Communications Materials Testing Plan		02/28/2024
Professional Recruitment Message Templates		02/29/2024
Social Determinants of Health		02/29/2024
Informed Consent Form (Online Survey)		02/29/2024
Informed Consent Form (Focus Group)		02/29/2024
Attachment List		02/29/2024

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

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