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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Project Engage 2.0: Engaging Gay "Community" Activism for Syphilis Prevention
Agency IC Tracking Number:
0920-0840 (18ARF)
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
Other-WORD
Att 5a-Eligibilty Screener.docx
No
Fillable Fileable
Other-WORD
Att 5b-Focus Group Guide.docx
No
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:
192
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
192
0
192
0
0
0
Annual IC Time Burden (Hours)
107
0
107
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SupSta A
SSA - Project Engage 2.0.docx
07/13/2018
SupStaB
SSB - Project Engage 2.0.docx
07/13/2018
Att 1_Autho Leg
Att 1-PHS Act Legislation.pdf
07/13/2018
Att 2_60dy FRN
Att 2-60 Day FRN.pdf
07/13/2018
Att 3a_Recruitment Flyer
Att 3a-Recruitment Flyer.pdf
07/13/2018
Att 3b_Recruitment Script
Att 3b-Recruitment Script.docx
07/13/2018
Att 4_Consent Form
Att 4-Consent Form.docx
07/13/2018
Att 6_ IRB Letter of Approval
Att 6-IRB Letter of Approval.pdf
07/13/2018
Att 7_Project Determination
Att 7-CDC Project Determination.pdf
07/13/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.