View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"
Agency IC Tracking Number:
0920-1091-19ATS
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
0920-1091
Deep South Client Screener (English)
Att 3a_Deep South Client Screener 3 26 2019.docx
No
Fillable Printable
Form and Instruction
0920-1091
Deep South CBO Client Interview Guide
Att 3b_Deep South Client Interview Guide 3 26 2019.docx
No
Paper Only
Form and Instruction
0920-1091
Deep South Staff Interview Guide
Att 3c_Deep South Staff Interview Guide.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
444
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
444
0
444
0
0
0
Annual IC Time Burden (Hours)
177
0
177
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 1_ Deep South Recruitment Flyers
Att 1_Deep South Recruitment Flyers.pdf
04/30/2019
Att 2_Deep South Informed Consent
Att 2_Deep South Informed Consent Forms.docx
04/30/2019
Att 4a _CDC IRB Approval
Att 4a_CDC IRB Approval Protocol 7152 Approval.docx
04/30/2019
Att 4b_Emory IRB Determination
Att 4b_Emory U IRB Determination.pdf
04/30/2019
Att 5_Data Use Plan
Att 5_Deep South Data Use Plan.doc
04/30/2019
Att 6_Privacy Impact Assessment
Att 6_Privacy Impact Assessment Approval.pdf
04/30/2019
2018 iQualR PIA
2018 iQualR PIA_signed 3 26 2019.pdf
04/30/2019
Supporting Statement A
SSA - HIV Prevention and Treatment (YMSM of Color) (YTG of Color) 0920-1091 3 26 2019.docx
04/30/2019
Supporting Statement B
SS B.docx
04/30/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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