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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
HIV Testing Factors among Rural Black Men and Family and Cultural Impact on STD and HIV Risk among Latino and African-American Youth
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 - Testing in Rural Black Men
Att_1a_Screening and Contact Form.docx
Yes
Yes
Fillable Fileable
Form
none
Survey - Testing in Rural Black Men
Att_1b_Survey Instrument.docx
Yes
Yes
Fillable Fileable
Form
none
Focus group guide - Testing in Rural Black Men
Att_1c_Focus Group Guide.10012010.docx
Yes
Yes
Fillable Fileable
Form
none
Focus group guide - Family and Cultural Impact
Att_1c_Focus Group Guide.docx
Yes
Yes
Fillable Fileable
Form
none
Focus group screener - Family and Cultural Impact
Att_1a_Focus Group Screener.docx
Yes
Yes
Fillable Fileable
Form
none
Survey screener - Family and Cultural Impact
Att_1b_Survey Screener.docx
Yes
Yes
Fillable Fileable
Form
none
Adult survey - Family and Cultural Impact
Att_1d_ ACASI Survey-Parents.docx
Yes
Yes
Fillable Fileable
Form
none
Adolescent survey - Family and Cultural Impact
Att_1e_ACASI Survey-Youth.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,858
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
3,858
0
0
0
0
0
Annual IC Time Burden (Hours)
2,310
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 - Testing in Rural Black Men
Brown_SS_SectA.OCT20.docx
12/13/2010
Local IRB Approval - Testing in Rural Black Men
Att_4b_Local IRB Approval.pdf
12/13/2010
Local IRB Approval - Testing in Rural Black Men
Att_4c_Local IRB Approval.pdf
12/13/2010
CDC Research Determination - Testing in Rural Black Men
Att_4a_CDC Determination.pdf
12/13/2010
Recruitment Flyer - Testing in Rural Black Men
Att_3a_Recruitment Flyer.10012010.docx
12/13/2010
Recruitment Script - Testing in Rural Black Men
Att_3b_Recruitment Script.10012010.docx
12/13/2010
Survey Consent -Testing in Rural Black Men
Att_2a_Survey Consent.10012010.docx
12/13/2010
Focus Group Consent - Testing in Rural Black Men
Att_2b_Focus Group_Consent.10012010.docx
12/13/2010
Supporting Statement - Family and Cultural Impact
SS_Part A.docx
12/13/2010
CDC determination - Family and Cultural Impact
Att_3a_Project Determination-CDC.docx
12/13/2010
Local IRB - Family and Cultural Impact
Att_3b_Local IRB Determination.docx
12/13/2010
Focus group recruitment flyer - Family and Cultural Impact
Att_4a_Focus Group Recruitment Flyer.docx
12/13/2010
Focus group recruitment script - Family and Cultural Impact
Att_4b_Focus Group Recruitment Script.docx
12/13/2010
Survey recruitment script - Family and Cultural Impact
Att_4d_Survey Recruitment Script.docx
12/13/2010
Survey recruitment flyer - Family and Cultural Impact
Att_4c_Survey Recruitment Flyer.docx
12/13/2010
Focus group consent - Family and cultural impact
Att_2a_ Focus Group Consent.docx
12/13/2010
Adult survey consent - Family and Cultural Impact
Att_2b_Adult Survey Consent.docx
12/13/2010
Adoloescent survey assent - Family and Cultural Impact
Att_2c_Adolescent Survey Assent .docx
12/13/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.