View Information Collection Request (ICR) Package
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View Information Collection (IC) List
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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:
201301-0920-010
Status:
Historical Active
Previous ICR Reference No:
200910-0920-004
Agency/Subagency:
HHS/CDC
Agency Tracking No:
18699
Title:
Formative Research and Tool Development
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/01/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/31/2013
Terms of Clearance:
Previous terms continue: 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
02/29/2016
36 Months From Approved
01/31/2013
Responses
121,800
0
121,800
Time Burden (Hours)
46,516
0
46,516
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Disease Control and Prevention (CDC) requests approval for a revised 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:
77 FR 46094
08/02/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 71794
12/04/2012
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
17
IC Title
Form No.
Form Name
CBO Needs Assessment for Preparedness and Resources for Support of Biomedical HIV Prevention
None, none
Biomedical HIV Prevention Organizational Assessment Web-based Survey Screenshots
,
Consent Form
DSTP Assessment of STD Clinic Users
none
DSTDP Assessment of STD Clinic Users
Development of CDC's Act Against AIDS Social Marketing Campaigns Targeting Consumers
Development of a Motion Comic for HIV/STI Prevention Among Young People Ages 15-24 Phase 2
none, none, none, none, none
Motion Comic Pre Test Survey
,
Motion Comic Focus Group Guide 2
,
Motion Comic Screener
,
Motion Comic Post Test Survey
,
Motion Comic Focus Group Guide 1
Evaluating HIV/AIDS Focused Video Game for Young People
none, none, none, none
Enrollment Day Survey
,
Experimental Group Survey
,
30 Day Post Survey
,
Demographic Screener
Evaluation of HIV Self-Testing Among MSM in High Prevalence Cities (eSTAMP)
none, none, none, none, none
Eligibility Screener
,
Registration
,
Baseline Survey
,
Reporting of Self-Test Results
,
Follow-up Survey
Feasibility of HIV Behavioral Surveillance for Young MSM
0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840
Attachment 4_Recruitment Debriefing
,
Attachment 5_Eligibility Screener
,
Attachment 6_Behavioral Assessment
,
Attachment 7_Key informant interview
,
Attachment 8_Focus Group Interview
,
Attachment 9_Enumeration Interview
,
Attachment 10_Landing Page and Banner Ad
Formative Research and Tool Development: Survey of HIV Medical Care Providers to Guide the Medical Monitoring Project
none, none
MMP Provider Survey
,
MMP Provider Survey Web-based Application Screenshots
Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC)
None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None, None
Provider Screening Instrument
,
Paper and Pencil Survey
,
Informed Consent Form
,
Provider Screening Instrument
,
Review Material-Envelope
,
Review Material Folder
,
Review Material Brouchure and Folding Instructions
,
Review Material Patient Baseline Screen
,
Review Material Patient Adherence Brochure
,
Review Material Adherence Wall Poster
,
Review Material Risk Reduction MD Brochure
,
Review Material Patient Action Plan
,
Review Material Patient Risk Reduction Brochure
,
Review Material Retention Brochure MD
,
Review Material Patient Record Form
,
Review Material Retention Brochure Patient
,
Review Material Retention Poster
,
Review Material Gardner Study Reprint
,
Review Material Adherence Brochure MD
,
CME Promotion Card
,
Review Material Risk Reduction Poster Option
Informing the Development of Mobile Apps for HIV Prevention, Treatment & Care
none, none, none, none, none, none, form, none, none, none, none, none, none, none, none, none, none
Screener
,
Screener High Risk
,
Screener HIV Providers
,
PLWH Guide
,
PLWH Guide Spanish
,
High Risk Guide
,
High Risk Guide Spanish
,
HC Providers Guide
,
Focus Group Assessment
,
Focus Group Assessment Spanish
,
End User Survey
,
Consent PLWH & High Risk
,
Consent PLWH & High Risk Spanish
,
Assent PLWH & High Risk
,
Consent HC Providers
,
Usability Consent
,
Usability Assent
Injection Behaviors Among Young Persons in Rural/Suburban Settings
none, none, none
Formative Research Study
,
Screener
,
Consent
Local Effectiveness Assessment Project (LEAP): A Case Study of a Local Jurisdiction Providing HIV Services to MSM
None, None, None, None
Interview Guide - Public Policy Stakeholders
,
Interview Guide - Community Leaders
,
Interview Guide - Individual/Network
,
Key Participant Information Sheet and Consent Form
Pilot Test Study for the HIV Risk Reduction Educational Tool (HRRET)
None, None, None
Pilot Study HRRET Screener Survey
,
Pilot Test HRRET PRETEST Web-based Survey
,
Pilot Test HRRET POSTTEST Web-based Survey
Testing Brief Messages for Black and Latino MSM
none, none, none, none, none, none
Eligibility Screener - English
,
Eligibility Screener -Spanish
,
Messages and Outcomes
,
Messages and Outcomes - Spanish
,
Assessment - English
,
Assessment - Spanish
Testing Messages for Black and Latino MSM
none, none, none, none
Eligibility Screener
,
Eligibility Screener - Spanish Version
,
Focus Group/Interview Guide
,
Focus Group/Interview Guide - Spanish Version
Testing Solutions for Sampling Challenges for MMP
none, none
2a - Interview questionnaire - English
,
2b - interview questionnaire - Spanish
Understanding Barriers and Facilitators to HIV Prevention, Care, and Treatment
none, none, none, none, none, none, none, none, none, none, none, none, none, none, none, none, none, none, none
Provider Demographic Questionnaire
,
Provider interview guide
,
Study screener - English
,
Study screener - Spanish
,
Discordant partners screeners - English
,
Discordant partners screener - Spanish
,
Contact Information - English
,
Contact Information - Spanish
,
Discordant partners contact info - English
,
Discordant partners contact info - Spanish
,
PLWH interview guide - English
,
PLWH interview guide - Spanish
,
Discordant partners interview guide - English
,
Discordant partners interview guide - Spanish
,
Provider info sheet and consent
,
PLWH consent
,
PLWH consent - Spanish
,
Discordant partner consent - English
,
Discordant partner consent - Spanish
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
121,800
0
0
0
0
Annual Time Burden (Hours)
46,516
46,516
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
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:
Thelma Sims 4046394771
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:
01/31/2013
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