View Information Collection (IC)
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View Information Collection (IC)

Evaluation of HIV Self-Testing Among MSM in High Prevalence Cities (eSTAMP)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Eligibility Screener Att 1a Eligibility Screener.docx Yes Yes Fillable Fileable
Form none Registration Att 1b Study Registration.docx Yes Yes Fillable Fileable
Form none Baseline Survey Att 1c Baseline Survey.docx Yes Yes Fillable Fileable
Form none Reporting of Self-Test Results Att 1d Reporting of Self-Test results.docx Yes No Fillable Fileable
Form none Follow-up Survey Att 1e Follow up Survey.docx Yes Yes Fillable Fileable
Other-Screenshots Att 4d Screen shots (2) (3).docx Yes Yes Fillable Fileable

Health Health Care Services

 

14,360 0
   
Individuals or Households
 
   0 %

  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 14,360 0 0 0 0 0
Annual IC Time Burden (Hours) 1,830 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Consent Att 2a Consent Form.docx 04/24/2013
IRB Att 3 IRB Emory.docx 04/24/2013
Self-test Referral Att 4a Self-test referral sheet.docx 04/24/2013
Banner Ad Sample Att 4b Banner Ad Example.docx 04/24/2013
Communication Messages Att 4c Communication Messages.docx 04/24/2013
Supporting Statement A SS Part A.docx 04/24/2013
Supporting Statement B SS Part B.docx 04/24/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.