View Information Collection Request (ICR) Package
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
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0920-0840
ICR Reference No:
200910-0920-004
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Formative Research and Tool Development
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/15/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/16/2009
Terms of Clearance:
OMB approves this umbrella generic, and has informed CDC that each individual study should be submitted into ROCIS an a genIC that includes the actual study instruments and a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2013
36 Months From Approved
Responses
121,800
0
0
Time Burden (Hours)
46,516
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Disease Control and Prevention (CDC) requests approval for a new generic information collection that supports formative research in HIV/AIDS, sexually transmitted diseases, tuberculosis, and viral hepatitis.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 10591
03/11/2009
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 46199
09/08/2009
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
14
IC Title
Form No.
Form Name
2012 Case-Surveillance-Based-Sampling Questionnaire for the Medical Monitoring Project (MPP)
None, OMB 0920-0740 - Medical History Form, OMB 0920-0840 Surveillance Period Summary Form, OMB 0920-0740 Surveillance Period Visit Form, 0920-0740 Surveillance Period Inpatient Form, None, None
2012 Case-Surveillance-Based-Sampling Questionnaire for The Medical Monitoring Project (MMP)
,
Medical Record Abstraction Form
,
Surveillance Period Summary Form
,
Surveillance Period Visit Form
,
Surveillance Period Inpatient Form
,
2012 CSBS Process Documentation Form
,
Model Patient Recruitment Script
Assessing the Accuracy of Self-Report of HIV Testing Behavior
none, none, none
Patient Survey
,
Medical Record Abstraction
,
Consent Form
Assessment of QDS Data Coll. System and Dev't of HIV Prev. Decision Support Messages and Form. Research for the Web-based HIV Beh. Survey among MSM
none, none, none, none, none, none, none, none, none, none
Assessment - Survey
,
Assessment - Screener
,
Message Testing - interview screener
,
Message Testing - Qualitative interview
,
Message Testing - Survey screener
,
Message Testing - Web-based Survey
,
Web-based Survey - Web Survey Screener
,
Web-based Survey - Focus Group Screener
,
Web-based Survey - Focus Group Interview
,
Web-based Survey - Web Survey Questionnaire
Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation - Spanish version
none, none
Eligibility screener - Spanish version
,
Baseline survey - Spanish version
Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM
none, none, none, none, none, none, none, none, none
HCV Testing - Denver screener
,
Recruitment - 1a Screener
,
HCV Testing - Focus Group Guide
,
HCV Testing - Screener
,
Recruitment - 1b Focus Group Interview
,
Recruitment - 1c Screener
,
Recruitment - 1d Web Survey
,
Recruitment - 3a Spanish Screener
,
Recruitment - 3b Spanish Survey
Development of a Motion Comic for HIV/STI Prevention among Young People
none, none, none, none, none, none
Study screener
,
Phase 1 focus group guide
,
Phase 3 focus group guide
,
Phase 2 focus group guide
,
Pre-test survey
,
Post-test Survey
Evaluation of Rapid HIV Self-Testing: Qualitative and User Proficiency Assessments
Field Assessment of a Comprehensive Manual for Hepatitis C Counseling and Testing
none, none, none
Recruitment Script
,
Interview
,
Check-in Questions
HIV Testing Factors among Rural Black Men and Family and Cultural Impact on STD and HIV Risk among Latino and African-American Youth
none, none, none, none, none, none, none, none
Screener - Testing in Rural Black Men
,
Survey - Testing in Rural Black Men
,
Focus group guide - Testing in Rural Black Men
,
Focus group guide - Family and Cultural Impact
,
Focus group screener - Family and Cultural Impact
,
Survey screener - Family and Cultural Impact
,
Adult survey - Family and Cultural Impact
,
Adolescent survey - Family and Cultural Impact
Local Needs Assessment of Program Collaboration and Service Integration Among Infectious Disease Prevention Providers for Persons Who Use Drugs Illicitly
MARI - Empowering Latinas to Lash Out Against AIDS (ELLAS)
none, none, none, none
Screener
,
Group Interview
,
Survey of Individual
,
Health Care Provider Interview
National TB Lab Services Survey and Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation
none, none, none
National TB Lab Services Survey
,
Assessment of QDS System-screener
,
Assessment of QDS System - survey
Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment
none, none, none, none
Screener
,
ACASI survey
,
Web-based sex diary
,
In-depth interview
Usability Study of Medscape's Technology-based Panel
none, none
Screener
,
Questionnaire
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
121,800
0
0
121,800
0
0
Annual Time Burden (Hours)
46,516
0
0
46,516
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new generic data collection.
Annual Cost to Federal Government:
$574,500
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Maryam Daneshvar 4046394604
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
10/16/2009
An official website of the United States government
The .gov means it's official.
The site is secure.
