Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2012 Case-Surveillance-Based-Sampling Questionnaire for the Medical Monitoring Project (MPP) New 1900 655 0 Form and Instruction None 2012 Case-Surveillance-Based-Sampling Questionnaire for The Medical Monitoring Project (MMP)
Form OMB 0920-0740 - Medical History Form Medical Record Abstraction Form
Form OMB 0920-0840 Surveillance Period Summary Form Surveillance Period Summary Form
Form OMB 0920-0740 Surveillance Period Visit Form Surveillance Period Visit Form
Form 0920-0740 Surveillance Period Inpatient Form Surveillance Period Inpatient Form
Form and Instruction None 2012 CSBS Process Documentation Form
Other-Consent Form--English
Other-Consent Form--Spanish
Form and Instruction None Model Patient Recruitment Script
Instruction
Assessing the Accuracy of Self-Report of HIV Testing Behavior New 1810 600 0 Form none Patient Survey
Form none Medical Record Abstraction
Form none Consent Form
Assessment of QDS Data Coll. System and Dev't of HIV Prev. Decision Support Messages and Form. Research for the Web-based HIV Beh. Survey among MSM New 17471 2497 0 Form none Assessment - Survey
Form none Assessment - Screener
Form none Message Testing - interview screener
Form none Message Testing - Qualitative interview
Form none Message Testing - Survey screener
Form none Message Testing - Web-based Survey
Form none Web-based Survey - Web Survey Screener
Form none Web-based Survey - Focus Group Screener
Form none Web-based Survey - Focus Group Interview
Form none Web-based Survey - Web Survey Questionnaire
Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation - Spanish version New 1 1 0 Form none Eligibility screener - Spanish version
Form none Baseline survey - Spanish version
Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM New 15156 2104 0 Form none HCV Testing - Denver screener
Form none Recruitment - 1a Screener
Form and Instruction none HCV Testing - Focus Group Guide
Form none HCV Testing - Screener
Form none Recruitment - 1b Focus Group Interview
Form none Recruitment - 1c Screener
Form none Recruitment - 1d Web Survey
Form none Recruitment - 3a Spanish Screener
Form none Recruitment - 3b Spanish Survey
Development of a Motion Comic for HIV/STI Prevention among Young People New 780 545 0 Form none Study screener
Form and Instruction none Phase 1 focus group guide
Form and Instruction none Phase 3 focus group guide
Form and Instruction none Phase 2 focus group guide
Form none Pre-test survey
Form none Post-test Survey
Evaluation of Rapid HIV Self-Testing: Qualitative and User Proficiency Assessments New 430 121 0 Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Field Assessment of a Comprehensive Manual for Hepatitis C Counseling and Testing New 240 70 0 Form none Recruitment Script
Form none Interview
Form none Check-in Questions
HIV Testing Factors among Rural Black Men and Family and Cultural Impact on STD and HIV Risk among Latino and African-American Youth New 3858 2310 0 Form none Screener - Testing in Rural Black Men
Form none Survey - Testing in Rural Black Men
Form none Focus group guide - Testing in Rural Black Men
Form none Focus group guide - Family and Cultural Impact
Form none Focus group screener - Family and Cultural Impact
Form none Survey screener - Family and Cultural Impact
Form none Adult survey - Family and Cultural Impact
Form none Adolescent survey - Family and Cultural Impact
Local Needs Assessment of Program Collaboration and Service Integration Among Infectious Disease Prevention Providers for Persons Who Use Drugs Illicitly New 300 156 0 Instruction
Instruction
Instruction
Instruction
MARI - Empowering Latinas to Lash Out Against AIDS (ELLAS) New 530 208 0 Form none Screener
Form none Group Interview
Form none Survey of Individual
Form none Health Care Provider Interview
National TB Lab Services Survey and Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation New 3308 2001 0 Form none National TB Lab Services Survey
Form none Assessment of QDS System-screener
Form none Assessment of QDS System - survey
Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment New 1780 745 0 Form none Screener
Form none ACASI survey
Form none Web-based sex diary
Form none In-depth interview
Usability Study of Medscape's Technology-based Panel New 16800 934 0 Form none Screener
Form none Questionnaire
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 64364 12947 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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