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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Informing Development of CDC Content about Sexually Transmitted Diseases: Interviews with Healthcare Providers
Agency IC Tracking Number:
0920-21CE
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
n/a
Recruitment Guide for Healthcare Professionals
Attachment C2_ Recruitment Guide HCPs.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Moderator Guides for Interviews with Healthcare Professionals
Attachment D2_Moderator Guides for HCP Interviews.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
40
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
40
0
40
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Part A
DSTDP MSM Message Testing Part 2 (HCPs) SSA_01052021.docx
01/05/2021
Supporting Statement Part B
DSTDP MSM Message Testing Part 2 (HCPs) SSB_01052021.docx
01/05/2021
HMTS GENIC Submission Template
HMTSExpeditedReviewForm_1220.pdf
01/05/2021
Authorizing Legislation: PHSA
Attachment A2_Authorizing Legislation.docx
01/05/2021
Consent Form
Attachment B2_Consent Forms for Healthcare Providers.docx
01/05/2021
Messages to be Tested
Attachment E2_MSM Messages to Test.docx
01/05/2021
CDC Determination: IRB Approval Is Not Required
Att F1_Project Determination Amendment 12 20.docx
01/05/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.