Formative Research to Inform an HIV Testing Social Marketing Campaign for African American Heterosexual Men

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Section B - Supporting Statement.doc	Supporting Statement B	Uploaded 2007-09-11	Available
A8 Confidentiality Agreement.doc	Supplementary Document	Uploaded 2007-09-13	Available
A5 CDC and RTI IRB Approvals.doc	Supplementary Document	Uploaded 2007-09-13	Available
60 Day FRN .pdf	Supplementary Document	Uploaded 2007-09-13	Available
A1 Authorizing Legislation.doc	Supplementary Document	Uploaded 2007-09-13	Available
A6 Consent Documents.doc	Supplementary Document	Uploaded 2007-09-13	Available
Section A - Supporting Statement.doc	Supporting Statement A	Uploaded 2007-10-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182369	Data Collection Instrument for Focus Groups	Other-Data Collection Instrument	New
182368	Data Collection Instrument for Interviews	Other-Data Collection Instrument	New
182367	Paper and Pencil Questionnaire	Other-Questionnaire	New
182366	Study Screener	Other-Study Screener	New

ICR Details

OMB Control No: 0920-0762	ICR Reference No: 200710-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Formative Research to Inform an HIV Testing Social Marketing Campaign for African American Heterosexual Men
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 without change	Conclusion Date: 01/24/2008
	Date Received in OIRA: 10/16/2007
Terms of Clearance: Approved consistent with the following terms of clearance: OMB approves the collection for purposes of formative research however results of the survey will not be generalizable to the populations surveyed and will not be reported as such.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved
Responses	297	0	0
Time Burden (Hours)	146	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this study is to conduct formative research to inform the development of a CDC-sponsored social marketing campaign that will be aimed at increasing HIV testing rates among young, single, African American heterosexual men.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Svc. Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 74541	12/12/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 52881	09/17/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Study Screener
Paper and Pencil Questionnaire
Data Collection Instrument for Interviews
Data Collection Instrument for Focus Groups

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ICR Summary of Burden

table that charts list 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	297	0	0	297	0	0
Annual Time Burden (Hours)	146	0	0	146	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 data collection.

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Annual Cost to Federal Government: $197,514

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 10/16/2007

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