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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM
Agency IC Tracking Number:
0920-0840-18AX
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
Survey screener
Att 1a Screener AMSM Survey_.docx
Yes
Yes
Fillable Fileable
Form
none
Survey - word
Att 1c AMSM_Trans Survey.docx
Yes
Yes
Fillable Fileable
Form
none
Survey AMSM - screenshots
Att 1d ScreenShots - AMSM.docx
Yes
Yes
Fillable Fileable
Form
none
Survey Trans - screenshots
Att 1e ScreenShots - Trans.docx
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:
7,875
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
7,875
0
7,875
0
0
0
Annual IC Time Burden (Hours)
1,677
0
1,677
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Survey Eligibility Flowchart
Att 1b AMSM Screener Diagram.pdf
10/19/2017
Flyer
Att 2 Consent & Assent Landing.docx
10/19/2017
IRB approval
Att 3a NORC IRB Approval Letter.pdf
10/19/2017
IRB Amendment
Att 3b NORC IRB Approval Amendment 1.pdf
10/19/2017
IRB amendment
Att 3c NORC IRB Approval Amendment 2.pdf
10/19/2017
IRB Renewal
Att 3d NORC IRB Renewal Letter.pdf
10/19/2017
IRB amendment
Att 3e NORC IRB Approval Amendment 3.pdf
10/19/2017
Explanation for Sensitive Questions
Att 3g Sensitive Questions.docx
10/19/2017
Web advertisement
Att 4a Web Recruitment Ads.docx
10/19/2017
Snapchat advertisement
Att 4b Snapchat Recruitment Ads.docx
10/19/2017
Snapchat video ads
Att 4c Example Snapchat Video.mp4
10/19/2017
System Security Plan
Att 5 Data Security Plan.docx
10/19/2017
Supporting statement B
SSB.10.19.docx
10/19/2017
Supporting Statement A
SSA.10.19.docx
10/19/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.