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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Sexual Health Study for Gay and Bisexual Men
Agency IC Tracking Number:
0920-0572-19AE
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
0920-0572
Screener - Understanding Sexual Health Messaging among Men who have Sex with Men
ATTACHMENT 2 ScreeningForm_noHIV 25OCT2019.docx
NA
No
Fillable Fileable
Form and Instruction
0920-0572
Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men
ATTACHMENT 4 FocusGroupModeratorGuide_8.31.2018.docx
NA
No
Paper 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:
460
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
460
0
460
0
0
0
Annual IC Time Burden (Hours)
93
0
93
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Shigella Infographic
18_294579-Shigella_Infographic_MSM.pdf
10/26/2018
Recruitment Script
ATTACHMENT 1 Recruitment Script.docx
10/26/2018
Informed Consent - GSU
ATTACHMENT 3 InformedConsent.docx
10/26/2018
IRB Approval - GSU
ATTACHMENT 5 GSU IRB Approval.pdf
10/26/2018
IRB Amendment Approval - GSU
GSU Outcome_Letter Sept 2018.pdf
10/26/2018
Shigella - Concept 1
Shigella_CDC_Concept_1.JPG
10/26/2018
Shigella - Concept 1A
Shigella_CDC_Concept_1A.JPG
10/26/2018
Shigella - Concept 2
Shigella_CDC_Concept_2.jpg
10/26/2018
Shigella - Concept 3
Shigella_CDC_Concept_3.jpg
10/26/2018
Expedited Review Form_HMTS GenIC Request
Expedited Review Form_MSM_Shigella_MessageTesting 31OCT2018.pdf
10/31/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.