View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Qualitative Research to Understand Consumer Opinions and Preferences for Emerging HIV Prevention Products among MSM in Atlanta, Houston, and Miami
Agency IC Tracking Number:
0920-20HK-2
IC Status:
Unchanged
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
n/a
Screener
Att 2a_Screener.docx
No
Paper Only
Form and Instruction
n/a
Contact Information Form
Att 2b_Contact information Form.docx
No
Paper Only
Form and Instruction
n/a
In-depth Interview Guide
Att 2c_In Depth Interview Guide.docx
No
Paper Only
Form and Instruction
n/a
Focus Group Guide
Att 2d_Focus Group Guide.docx
No
Paper Only
Form and Instruction
n/a
Survey for Participants Currently on PrEP
Att 2e_Survey on PrEP.docx
No
Paper Only
Form and Instruction
n/a
Survey for Participants Currently Not on PrEP
Att 2f_Survey not on PrEP.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
01-36-0216, Epidemiologic Studies and Surveillance of Disease Problems, HHS/CDC
FR Citation:
57 FR 62812
Number of Respondents:
240
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
240
0
0
0
0
240
Annual IC Time Burden (Hours)
220
0
0
0
0
220
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Recruitment Materials
Att 1_Recruitment Materials.pdf
05/15/2020
Consent for Interview
Att 3a_Consent for Interview.docx
05/15/2020
Consent for Focus Group
Att 3b_Consent for Focus Group.docx
05/15/2020
IRB Approval
Att 4_IRB Approval.docx
05/15/2020
Data Use Plan
Att 5_Data Use Plan.docx
05/15/2020
Privacy Impact Assessment
Att 6_Privacy Impact Assessment.pdf
05/15/2020
Product Graphics
Att 7_Product Graphics.docx
05/15/2020
Show Cards
Att 8_Show Cards.docx
05/15/2020
Supporting Statement Part A
SSA Final.docx
05/15/2020
Supporting Statement Part B
SSB Final.docx
05/15/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.