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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM
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
HCV Testing - Denver screener
Att_5a_Denver AlertHealth Screening and Contact Form 02222012.doc
No
No
Paper Only
Form
none
Recruitment - 1a Screener
Att 1a_Eligibility Screener_Focus Group.docx
Yes
Yes
Fillable Fileable
Form and Instruction
none
HCV Testing - Focus Group Guide
Att_1a_Interview and Focus Group Guide.docx
No
No
Paper Only
Form
none
HCV Testing - Screener
Att_5b_Community Health Awareness Group Screening and Contact Form.doc
No
No
Paper Only
Form
none
Recruitment - 1b Focus Group Interview
Att 1b_Focus Group Interview.docx
Yes
Yes
Fillable Fileable
Form
none
Recruitment - 1c Screener
Att 1c Eligibility Screener_Web-based survey.docx
Yes
Yes
Fillable Fileable
Form
none
Recruitment - 1d Web Survey
Att 1d Web-based survey.docx
Yes
Yes
Fillable Fileable
Form
none
Recruitment - 3a Spanish Screener
Att 3a Eligibility Screener (Spanish).docx
Yes
Yes
Fillable Fileable
Form
none
Recruitment - 3b Spanish Survey
Att 3b Behavioral Assessment Survey (Spanish).docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15,156
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
95 %
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
15,156
0
0
0
0
0
Annual IC Time Burden (Hours)
2,104
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
HCV Testing - Supporting Statement A
SupportinStatement A.docx
02/29/2012
Recruitment - Supporting Statement A
Supporting Statement - Part A.docx
02/29/2012
HCV Testing - 4b MI IRB
Att_4b_Local IRB Approval - Wayne State Univ IRB.pdf
02/29/2012
HIV Testing - 4a CO IRB
Att_4a_Local IRB Approval - Colorado IRB.pdf
02/29/2012
HIV Testing - 2c - Info Sheet
Att_2c_Staff and Client Interview and Focus Group Information Sheet.doc
02/29/2012
HIV Testing - 2a Staff Consent
Att_2a_Staff Interview and Focus Group Consent 02222012.doc
02/29/2012
HCV Testing - 2b Client Consent
Att_2b_Client Interview and Focus Group Consent 02222012.doc
02/29/2012
HCV Testing - 3b Fact sheet
Att_3b_Fact Sheet Living with Chronic Hepatitis C.doc
02/29/2012
HCV Testing - 3a Fact Sheet
Att_3a_Fact Sheet Info about Testing Hep C.doc
02/29/2012
Recruitment - Supporting Statement B
Supporting Statement - Part B.docx
02/29/2012
Recruitment - 2a Consent
Att 2a Consent_focus group.docx
02/29/2012
Recruitment - 2b Web Consent
Att 2b_Consent_web-based survey.docx
02/29/2012
Recruitment - Survey screenshots
Att 1h Screen Shots of Survey.pdf
02/29/2012
Recruitment - 3 IRB Letter
Att 3 Emory IRB Approval Letter.pdf
02/29/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.