View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Pilot Test Study for the HIV Risk Reduction Educational Tool (HRRET)	Agency IC Tracking Number:	15FT

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 and Instruction	None	Pilot Study HRRET Screener Survey	Att2_Screener.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Pilot Test HRRET PRETEST Web-based Survey	Att3a_PreTest.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Pilot Test HRRET POSTTEST Web-based Survey	Att3b_PostTest.pdf	None	Yes	Yes	Fillable Fileable
Other-HRRET Website Content			Att 10_HRRET Screenshots 11DEC2014.pdf	None	Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	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	12,000	0	12,000	0	0	0
Annual IC Time Burden (Hours)	1,750	0	1,750	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation	Att 1_Sect 301 PHSA.pdf	12/09/2014
HRRET Screener Survey - WORD	Att 2_Screener (2).docx	12/09/2014
HRRET Exploration Period	Att 2a_Exploration Period.docx	12/09/2014
HRRET PRETEST Survey - WORD	Att 3a_Pretest Survey.docx	12/09/2014
HRRET POSTTEST Survey - WORD	Att 3b_Posttest Survey.docx	12/09/2014
HRRET Sample Email reminder	Att 4_Email Reminder.docx	12/09/2014
HRRET Study Consent	Att 5_Study Consent.doc	12/09/2014
HRRET Recruitment Ads	Att 6_Recruitment Ads.doc	12/09/2014
HRRET Sample Google Ad	Att 7_Sample Google Ad.docx	12/09/2014
HRRET Message Topics	Att 8_Message Topics.doc	12/09/2014
HRRET Sample Amazon Delivery Template	Att 9_Sample Amazon Delivery Template.doc	12/09/2014
Supporting Statement A	Supporting Statement A 11DEC2014.doc	12/12/2014
Supporting Statement B	Supporting Statement B 11DEC2014.docx	12/12/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.