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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
CBO Needs Assessment for Preparedness and Resources for Support of Biomedical HIV Prevention
New
895
323
0
Other-Pre-test Telephone Interview Script
Form
None
Biomedical HIV Prevention Organizational Assessment Web-based Survey Screenshots
Form
none
Consent Form
DSTP Assessment of STD Clinic Users
New
4400
733
0
Other-Consent
Form
none
DSTDP Assessment of STD Clinic Users
Development of CDC's Act Against AIDS Social Marketing Campaigns Targeting Consumers
New
5038
2061
0
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Other-WORD
Development of a Motion Comic for HIV/STI Prevention Among Young People Ages 15-24 Phase 2
New
540
275
0
Form
none
Motion Comic Pre Test Survey
Form
none
Motion Comic Focus Group Guide 2
Form
none
Motion Comic Screener
Form
none
Motion Comic Post Test Survey
Form
none
Motion Comic Focus Group Guide 1
Evaluating HIV/AIDS Focused Video Game for Young People
New
700
129
0
Form
none
Enrollment Day Survey
Form
none
Experimental Group Survey
Form
none
30 Day Post Survey
Form
none
Demographic Screener
Evaluation of HIV Self-Testing Among MSM in High Prevalence Cities (eSTAMP)
New
14360
1830
0
Form
none
Eligibility Screener
Form
none
Registration
Form
none
Baseline Survey
Form
none
Reporting of Self-Test Results
Form
none
Follow-up Survey
Other-Screenshots
Feasibility of HIV Behavioral Surveillance for Young MSM
New
5446
1715
0
Form and Instruction
0920-0840
Attachment 4_Recruitment Debriefing
Form and Instruction
0920-0840
Attachment 5_Eligibility Screener
Form and Instruction
0920-0840
Attachment 6_Behavioral Assessment
Form and Instruction
0920-0840
Attachment 7_Key informant interview
Form and Instruction
0920-0840
Attachment 8_Focus Group Interview
Form and Instruction
0920-0840
Attachment 9_Enumeration Interview
Form and Instruction
0920-0840
Attachment 10_Landing Page and Banner Ad
Formative Research and Tool Development: Survey of HIV Medical Care Providers to Guide the Medical Monitoring Project
New
5400
1300
0
Form
none
MMP Provider Survey
Form
none
MMP Provider Survey Web-based Application Screenshots
Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC)
New
480
154
0
Form and Instruction
None
Provider Screening Instrument
Form
None
Paper and Pencil Survey
Form
None
Informed Consent Form
Form and Instruction
None
Provider Screening Instrument
Form
None
Review Material-Envelope
Form
None
Review Material Folder
Form
None
Review Material Brouchure and Folding Instructions
Form
None
Review Material Patient Baseline Screen
Form
None
Review Material Patient Adherence Brochure
Form
None
Review Material Adherence Wall Poster
Form
None
Review Material Risk Reduction MD Brochure
Form
None
Review Material Patient Action Plan
Form
None
Review Material Patient Risk Reduction Brochure
Form
None
Review Material Retention Brochure MD
Form
None
Review Material Patient Record Form
Form
None
Review Material Retention Brochure Patient
Form
None
Review Material Retention Poster
Form
None
Review Material Gardner Study Reprint
Form
None
Review Material Adherence Brochure MD
Form
None
CME Promotion Card
Form
None
Review Material Risk Reduction Poster Option
Informing the Development of Mobile Apps for HIV Prevention, Treatment & Care
New
692
206
0
Form
none
Screener
Form
none
Screener High Risk
Form
none
Screener HIV Providers
Form
none
PLWH Guide
Form
none
PLWH Guide Spanish
Form
none
High Risk Guide
Form
form
High Risk Guide Spanish
Form
none
HC Providers Guide
Form
none
Focus Group Assessment
Form
none
Focus Group Assessment Spanish
Form
none
End User Survey
Form
none
Consent PLWH & High Risk
Form
none
Consent PLWH & High Risk Spanish
Form
none
Assent PLWH & High Risk
Form
none
Consent HC Providers
Form
none
Usability Consent
Form
none
Usability Assent
Injection Behaviors Among Young Persons in Rural/Suburban Settings
New
2400
394
0
Form
none
Formative Research Study
Form
none
Screener
Form
none
Consent
Local Effectiveness Assessment Project (LEAP): A Case Study of a Local Jurisdiction Providing HIV Services to MSM
New
60
33
0
Form and Instruction
None
Interview Guide - Public Policy Stakeholders
Form and Instruction
None
Interview Guide - Community Leaders
Form and Instruction
None
Interview Guide - Individual/Network
Form and Instruction
None
Key Participant Information Sheet and Consent Form
Pilot Test Study for the HIV Risk Reduction Educational Tool (HRRET)
New
12000
1750
0
Form and Instruction
None
Pilot Study HRRET Screener Survey
Form and Instruction
None
Pilot Test HRRET PRETEST Web-based Survey
Form and Instruction
None
Pilot Test HRRET POSTTEST Web-based Survey
Other-HRRET Website Content
Testing Brief Messages for Black and Latino MSM
New
3780
1455
0
Form
none
Eligibility Screener - English
Form
none
Eligibility Screener -Spanish
Form
none
Messages and Outcomes
Form
none
Messages and Outcomes - Spanish
Form
none
Assessment - English
Form
none
Assessment - Spanish
Testing Messages for Black and Latino MSM
New
270
150
0
Form and Instruction
none
Eligibility Screener
Form and Instruction
none
Eligibility Screener - Spanish Version
Form and Instruction
none
Focus Group/Interview Guide
Form and Instruction
none
Focus Group/Interview Guide - Spanish Version
Testing Solutions for Sampling Challenges for MMP
New
2850
983
0
Form
none
2a - Interview questionnaire - English
Form
none
2b - interview questionnaire - Spanish
Understanding Barriers and Facilitators to HIV Prevention, Care, and Treatment
New
590
167
0
Form
none
Provider Demographic Questionnaire
Form and Instruction
none
Provider interview guide
Form
none
Study screener - English
Form
none
Study screener - Spanish
Form
none
Discordant partners screeners - English
Form
none
Discordant partners screener - Spanish
Form
none
Contact Information - English
Form
none
Contact Information - Spanish
Form
none
Discordant partners contact info - English
Form
none
Discordant partners contact info - Spanish
Form and Instruction
none
PLWH interview guide - English
Form and Instruction
none
PLWH interview guide - Spanish
Form and Instruction
none
Discordant partners interview guide - English
Form and Instruction
none
Discordant partners interview guide - Spanish
Form and Instruction
none
Provider info sheet and consent
Form and Instruction
none
PLWH consent
Form and Instruction
none
PLWH consent - Spanish
Form and Instruction
none
Discordant partner consent - English
Form and Instruction
none
Discordant partner consent - Spanish
Total Burden Actually Used for Information Collections Under Currently Approved ICR:
59901
13658
0
Total Burden Currently Requested for Information Collections Under Currently Approved ICR:
0
0
0
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