Information Collection

African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects

IC 192323 under ICR 200807-0920-007 · OMB 0920-0798.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0798 can be found here:

2010-11-17 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects	Form
Emergency Risk Communication Network Needs Assessment Attachment A.doc	Form
AA STD Disparities -Phase I Interview Guide for Triads 0920-0798-Attachment 2- Phase I Guide used for Triad Discussions - 7-22.doc	Form
AA STD Disparities - Phase I Interview Guide for Individ 0920-0798-Attachment 3- Phase I Interview Guide used for Individual Interviews- 7-22.doc	Form
AA STD Disparities - Phase II Interview Guide for Indivi 0920-0798-Attachment 6- Phase II- Individual Interview Guide 6-29.doc	Form
AA STD Disparities - Demographic and Behavioral Question 0920-0798-Attachment 4- Participant Demographic and Behavioral Pencil Paper Questionaire- 2 18 10.doc	Form
AA STD DIsparities - Participant Domain Assessment 0920-0798-Attachment 5- Particpant Domain Assesment Structured Data Collection- 2.18.10.doc	Form
AA STD Disparities - Triad and Interview Screener 0920-0798-Attachment 9- Triad Interview Screener-2.18.10.doc	Form
RCom Letters of Request to Participate 2-22-10.doc Emergency Risk Communication Network - Invitation to Participate	IC Document
RCOM ICR Package 11-16-09.doc Emergency Risk Communication Network - Supporting Statement	IC Document
AttachmentB.doc Emergency Risk Communication Network - Pilot Protocol	IC Document
Backup of 0920-0798-AA STD disparity project-Section A- 12-07-09.wbk AA STD Disparities - Supporting Statement	IC Document
0920-0798-Attachment 12- Consent Forms 2.18.10.doc AA STD Disparities - Consent Forms	IC Document
0920-0798-Attachment 10- Reminder Letters E-Mails Phone Scripts- 2 18 10.doc AA STD Disparities - Reminders	IC Document
Attachment 7 IRB Determination.doc AA STD Disparities - IRB Determination	IC Document
0920-0798-Attachment 8- Recruitment Materials.doc AA STD Disparities - Recruitment Materials	IC Document
0920-0798-Attachment 11- Confidentiality Agreement.doc AA STD Dispariies - Confidentiality Agreement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

African American STD Disparities Health Communication and Emergency Risk Communication Network Needs Assessment Projects

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Emergency Risk Communication Network Needs Assessment	Attachment A.doc	Yes	Yes	Fillable Fileable
Form	none	AA STD Disparities -Phase I Interview Guide for Triads	0920-0798-Attachment 2- Phase I Guide used for Triad Discussions - 7-22.doc	No	No	Paper Only
Form	none	AA STD Disparities - Phase I Interview Guide for Individuals	0920-0798-Attachment 3- Phase I Interview Guide used for Individual Interviews- 7-22.doc	No	No	Paper Only
Form	none	AA STD Disparities - Phase II Interview Guide for Individuals	0920-0798-Attachment 6- Phase II- Individual Interview Guide 6-29.doc	No	No	Paper Only
Form	none	AA STD Disparities - Demographic and Behavioral Questionnaire	0920-0798-Attachment 4- Participant Demographic and Behavioral Pencil Paper Questionaire- 2 18 10.doc	No	No	Paper Only
Form	none	AA STD DIsparities - Participant Domain Assessment	0920-0798-Attachment 5- Particpant Domain Assesment Structured Data Collection- 2.18.10.doc	No	No	Paper Only
Form	none	AA STD Disparities - Triad and Interview Screener	0920-0798-Attachment 9- Triad Interview Screener-2.18.10.doc	No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,048

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	1,048	0	0	0	0	0
Annual IC Time Burden (Hours)	365	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Emergency Risk Communication Network - Invitation to Participate	RCom Letters of Request to Participate 2-22-10.doc	03/04/2010
Emergency Risk Communication Network - Supporting Statement	RCOM ICR Package 11-16-09.doc	03/04/2010
Emergency Risk Communication Network - Pilot Protocol	AttachmentB.doc	03/04/2010
AA STD Disparities - Supporting Statement	Backup of 0920-0798-AA STD disparity project-Section A- 12-07-09.wbk	03/04/2010
AA STD Disparities - Consent Forms	0920-0798-Attachment 12- Consent Forms 2.18.10.doc	03/04/2010
AA STD Disparities - Reminders	0920-0798-Attachment 10- Reminder Letters E-Mails Phone Scripts- 2 18 10.doc	03/04/2010
AA STD Disparities - IRB Determination	Attachment 7 IRB Determination.doc	03/04/2010
AA STD Disparities - Recruitment Materials	0920-0798-Attachment 8- Recruitment Materials.doc	03/04/2010
AA STD Dispariies - Confidentiality Agreement	0920-0798-Attachment 11- Confidentiality Agreement.doc	03/04/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.