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View Information Collection (IC)
View Information Collection (IC)
IC Title:
MSM AYA Stakeholder Analysis Survey
Agency IC Tracking Number:
15AMC
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
NA
Stakeholder Analysis Adolescent Online Survey
Revise Att1 Stakeholder Analysis Adolescent Survey.docx
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
Stakeholder Analysis MSM Online Survey
Att2 Stakeholder Analysis MSM Survey 23JUL2015.docx
NA
Yes
Yes
Fillable Fileable
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:
150
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
150
0
150
0
0
0
Annual IC Time Burden (Hours)
25
0
25
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for GenIC Approval 0920-1027
Request - MSM AYA Stakeholder Analysis Survey Generic Qualitative Feedback 23JUL2015.docx
07/29/2015
IRB Approval Study #1
IRB Approval MSM-AYA Study #1.pdf
07/29/2015
Recruitment Plan for MSM/AYA Stakeholder Survey
Recruitment Plan for MSM and AYA Stakeholder Assessment Survey Updated 4.28.15.docx
07/29/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.