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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0920-0840
ICR Reference No:
201511-0920-001
Status:
Historical Active
Previous ICR Reference No:
201301-0920-010
Agency/Subagency:
HHS/CDC
Agency Tracking No:
18699
Title:
Formative Research and Tool Development
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/26/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/16/2015
Terms of Clearance:
Previous terms continue: OMB approves this umbrella generic, and has informed CDC that each individual study should be submitted into ROCIS an a genIC that includes the actual study instruments and a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2019
36 Months From Approved
02/29/2016
Responses
121,800
0
121,800
Time Burden (Hours)
46,516
0
46,516
Cost Burden (Dollars)
0
0
0
Abstract:
The data collection and evidence are developed using a multitude of information sources and short term qualitative interviewing and cognitive research techniques have been proven invaluable in the development of scientifically valid and population-appropriate methods, interventions, and instruments. The activities conducted under this information collection will be used to inform many aspects of surveillance, communications, health promotion, and research project development for the 4 priority diseases (HIV, STDs, TB, and viral hepatitis) as well as school and adolescent health.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
80 FR 36540
06/25/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 66007
10/28/2015
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
2018 Congenital Syphilis Study
0920-0840, 0920-0840, 0920-0840, 0920-0840
Eligibility Screener - Prenatal Care Providers
,
Interview Guide - Prenatal Care Providers
,
Eligibility Sreener - Pregnant Women
,
Interview Guide - Pregnant Women
Assessment of STD Service Needs and Provisions
none, none
Patient Questionnaire
,
Administrative Questionnaire
Developing Tools to Engage Adolescent Men Who Have Sex with Men (AMSM)
n/a, n/a, n/a, n/a, n/a, n/a
Screener for In-person AMSM and Transgender Focus Groups
,
Screener for Online AMSM and Transgender Focus Groups
,
AMSM Focus Group Guide
,
Screenshots of AMSM Focus Group Guide
,
Transgender Youth Focus Group Guide
,
Screenshots of Transgender Youth Focus Group Guide
Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study
NA, NA, NA, NA, NA
Eligibility Screening Form - Online
,
Contact Information Form - Online
,
Eligibility Screening Form - Reverification
,
Focus Group Guide
,
In-Depth Interview Guide
Examination of Jail and Prison Policies Related to STD Prevention
NA
Vulnerable Populations Project Key Informant Interview Guide
Formative Research on Resilience and Transgender Youth
N/A, N/A
Qualitative Interview Guide
,
Eligibility Screener
Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM
none, none, none, none
Survey screener
,
Survey - word
,
Survey AMSM - screenshots
,
Survey Trans - screenshots
Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP
0920-0840
Interview Guide
Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District
N/A
Middle School Focus Group Guide
Project Engage 2.0: Engaging Gay "Community" Activism for Syphilis Prevention
Project Engage: Engaging Gay "Community" Activism for Syphilis Prevention
NA, NA
Eligibility Screener
,
Telephone Interview Guide
Student and Teacher Perspectives on Sexual Health Education in Fort Worth Independent School District
0920-16ML, 0920-16ML, 0920-16ML, 0920-16ML
Att 2-Teacher Interview Guide
,
Att 4-Middle School Student Focus Group Guide
,
Att 5-High School Student Focus Group Guide
,
Att 8-Teacher Interview Consent Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
121,800
121,800
0
0
0
0
Annual Time Burden (Hours)
46,516
46,516
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$574,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Thelma Sims 4046394771
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
11/16/2015
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