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:
Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St
Agency IC Tracking Number:
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
none
Screener - screenshots
Att 3a_Screener CAPI Screenshots_new.pdf
Yes
Yes
Fillable Fileable
Form
none
Contact information form
Att 3b_Contact Information Form_new.docx
Yes
Yes
Fillable Fileable
Other-Interview guide
Att 3c_IDI Guide and Showcards_new.docx
Yes
Yes
Fillable Fileable
Form
none
Demographic behavioral CAPI - screenshots
Att 3d_Demographic Behavioral CAPI Screenshots_new.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
390
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
390
0
390
0
0
0
Annual IC Time Burden (Hours)
98
0
98
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_Auth Legislation.pdf
10/14/2020
Recruitment flyer
Att 2_Recruitment Flyer_new.pdf
10/14/2020
Consent
Att 4 Informed Consent_new.docx
10/14/2020
IRB Approval
Att 5_CDC IRB Approval.docx
10/14/2020
Data use plan
Att 6_Data Use Plan.docx
10/14/2020
PIA
Att 7_iQualR PIA_signed.pdf
10/14/2020
Explanation of need for change of procedures
Explanation of COVID related GenIC Change.docx
10/14/2020
Supporting statement B
SS B_Clean.docx
10/14/2020
SSA
SS A_Clean11.10.20.docx
11/12/2020
IRB Amendment
Att 5a_ Amendment IRB Approval 1 Protocol #7224 (002).pdf
11/12/2020
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.