Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey Modified 850 142 0 Form and Instruction 0920-1357 Study Visit Survey
Form and Instruction 0920-1357 GAIN Study Visit Survey - Revised 09SEP2022
Acceptability/Feasibility Assessment Among Clinical and Community Providers Modified 100 100 0 Form and Instruction 0920-1357 Participant Focus Group/Interview Guide Gay City and Madison Clinic Testing, PEP & PrEP (participants testing negative only)
Baseline Data Collection Unchanged 2 4 77 Instruction
HIV-negative Patients Seeking HIV Testing - ROI Form Modified 50 8 0 Form and Instruction 0920-1357 Patient Authorization to Disclose, Release and/or Obtain Protected Health Information
HIV-negative Patients Seeking HIV Testing - Study Visit Survey Modified 50 13 0 Form 0920-1357 Study Visit Survey (SCREENSHOTS)
Form 0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 (SCREENSHOTS)
HIV-negative Patients Seeking HIV Testing and/or PrEP Services - ROI Form Modified 850 142 0 Form and Instruction 0920-1357 Patient Authorization to Disclose, Release and/or Obtain Protected Health Information
Monthly Study Report Form Unchanged 24 6 115 Form and Instruction n/a Monthly Study Report Form
POC NAT Acceptability Survey Modified 500 167 3190 Form and Instruction 0920-1357 NAT Acceptability Survey (SCREENSHOTS)
Participants in Cross-sectional Comparison of Several POC NATs - ROI Form Unchanged 333 56 1062 Form and Instruction n/a Release of Information Form
Participants in Cross-sectional Comparison of Several POC NATs - Study Visit Survey Unchanged 333 83 1593 Form and Instruction n/a Study Visit Survey
Form and Instruction 0920-1357 GAIN Study Visit Survey - Revised 09SEP2022
RCT of POC NAT or Standard of Care for HIV-positive Patients - ROI Form Modified 212 35 0 Form and Instruction 0920-1357 Patient Authorization to Disclose, Release and/or Obtain Protected Health Information
RCT of POC NAT or Standard of Care for HIV-positive Patients - Study Visit Form Modified 212 53 0 Form 0920-1357 Study Visit Survey (SCREENSHOTS)
Form and Instruction 0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 (SCREENSHOTS)
Total burden requested under this ICR: 3516 809 6037  
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