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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Screener
Attachment 1a_Screening and Contact Info Forms.06262010.docx
Yes
Yes
Fillable Fileable
Form
none
ACASI survey
Attachment 1b_ACASI Survey.06262010.docx
Yes
Yes
Fillable Fileable
Form
none
Web-based sex diary
Attachment 1c_Web-based Sex Diary.06262010.docx
Yes
Yes
Fillable Fileable
Form
none
In-depth interview
Attachment 1d_In-depth Interviews.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
730
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,780
0
0
0
0
0
Annual IC Time Burden (Hours)
745
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting statement A
SS Part A.06262010.docx
07/14/2010
Supporting statement B
SS Part B.docx
07/14/2010
Attachment 2 - Consent forms
Attachment 2_Consent Forms.06262010.docx
07/14/2010
Attachment 4 - Recruitment materials
Attachment 4_Recruitment Materials and Website Screenshots.06262010.docx
07/14/2010
Attachment 3 - IRB approval
Attachment 3a_local IRBapproval.April 2011.pdf
07/14/2010
Attachment 5 - Certificate of confidentiality
Attachment 5_Certificate of Confidentiality.pdf
07/14/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.