View Information Collection Request (ICR) Package
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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 ICR - OIRA Conclusion
OMB Control No:
0920-1423
ICR Reference No:
202509-0920-006
Status:
Active
Previous ICR Reference No:
202412-0920-015
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-25-0174
Title:
[NCHHSTP] Expanding PrEP in Communities of Color (EPICC)
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/23/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/22/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2026
12/31/2026
12/31/2026
Responses
1,244
0
1,244
Time Burden (Hours)
759
0
759
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of this study is to implement and evaluate the effectiveness of a clinic-based intervention that utilizes evidence-based education and support tools to 1) increase provider knowledge of and comfort with HIV preexposure prophylaxis (PrEP) modalities in clinical practice and 2) improve PrEP adherence among young men and non-binary persons who have sex with men (YMSM). This Change Request is submitted to modify language to comply with EO 14168. There is no anticipated change to the approved burden.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: U.S. PHSA
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:
88 FR 41623
06/27/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 62793
09/13/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
19
IC Title
Form No.
Form Name
Aim 1 Provider Patient Interaction (Baseline and Final)
0920-22GA
Att 4e_Aim1ProviderPatientInteraction
Aim 1 Provider Post-Training Survey
0920-22GA
Att 4d_Aim1ProviderPostTrainingSurvey
Aim 1 Provider Pre- Training Survey
MOD00003217
Aim 1 Provider Pre-Training Survey
Aim 1 Provider Training Contact Information
0920-22GA
Att 4b_Aim1ProviderTrainingContactInformation
Aim 1 Provider Training Screener
0920-22GA
Att 4a_Aim1ProviderTrainingScreener
Aim 2a Cohort App Setup (English/Spanish)
0920-1423, 0920-22GA
Att 4j_Aim2aCohortAppSetupEnglishSpanish
,
Att 4j - Aim2a Cohort App Setup English-Spanish _REV 19SEP2025
Aim 2a Cohort Baseline Survey (English/Spanish)
0920-22GA, 0920-22GA, 0920-1423, 0920-1423
Att 4i_Aim2aCohortBaselineSurveyEnglish
,
Att 4i_Aim2aCohortBaselineSurveySpanish
,
Att 4i - Aim2a Cohort Baseline Survey English_REV 19SEP2025
,
Att 4i - Aim2a Cohort Baseline Survey Spanish_REV 19SEP2025
Aim 2a Cohort Blood Collection Instructions (English/Spanish)
0920-22GA, 0920-1423, 0920-1423
Att 4l_Aim2a Cohort Blood Collection Instructions English
,
Aim 2a Cohort Blood Collection Instructions_English
,
Aim 2a Cohort Blood Collection Instructions_Spanish
Aim 2a Cohort Contact Information (English/Spanish)
0920-22GA
Att 4b_Aim1ProviderTrainingContactInformation
Aim 2a Cohort Exit Interview (English/Spanish)
0920-22GA, 0920-22GA, 0920-1423, 0920-1423
Att 4m_Aim2a Cohort Exit Interview English
,
Att 4m_Aim2aCohortExitInterviewSpanish
,
Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP2025
,
Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP2025
Aim 2a Cohort Follow Up Survey (English/Spanish)
0920-1423-24BY, MOD00003217, 0920-1423, 0920-1423
Aim 2a Cohort Follow Up Survey English
,
Encuesta de seguimiento de cohortes (Aim2aCohortFollowUpSurveySpanish)
,
Att 4k - Aim2a Cohort Follow-up Survey English_REV 19SEP2025
,
Att 4k - Aim2a Cohort Follow-up Survey Spanish_REV 19SEP2025
Aim 2a Cohort HIPAA Form (English & Spanish)
0920-22GA, 0920-22GA
Att 4h_Aim2aCohortHIPAAFormEnglish
,
Att 4h_Aim2aCohortHIPAAFormSpanish
Aim 2a Cohort Screener (English/Spanish)
MOD00003217, V2023-1102, 0920-1423, 0920-1423, 0920-1423, 0920-1423
Aim 2a Cohort Screener English
,
Elegibilidad de cohorte (Aim2aCohortScreener_Spanish)
,
Aim 2a - Cohort Screeeer_English
,
Aim 2a - Cohort Screeeer_Spanish
,
Att 4f - Aim2a Cohort Screener English_REV 19SEP2025
,
Att 4f - Aim2a Cohort Screener Spanish_REV 19SEP2025
Aim 2b Provider Focus Group Contact Information
0920-22GA
Att 4o_Aim2b Provider FocusGroup Contact Information
Aim 2b Provider Focus Group Guide
0920-1423, 0920-22GA
Att 4o_Aim2b Provider FocusGroup Contact Information
,
Att 4q_Aim2b Provider Focus Group Guide _REV 19SEP2025
Aim 2b Provider Focus Group Screener
0920-22GA
Att_4n_Aim2bProvider FocusGroup Screener
Aim 2b Provider Pre-Focus Group Survey
0920-22GA, 0920-1423, 0920-1423
Att 4p_Aim2b Provider Pre FocusGroup Survey
,
Aim 2b Provider Pre-Focus Group Survey_23DEC2024
,
Att 4p_Aim2b Provider Pre-Focus Group Survey _REV 19SEP2025
Aims 1&2 Clinic Assessment (Baseline & Final)
0920-22GA
Att 4r_Aim1&2ClinicAssessmentBaselineAndFinal
Aims 1&2 Clinic Assessment (every 6 months)
0920-22GA
Aims 1&2 Clinic Assessment (every 6 months)
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
1,244
1,244
0
0
0
0
Annual Time Burden (Hours)
759
759
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:
$1,112,799
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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?
No
Agency Contact:
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
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:
09/22/2025
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