Formative Research and Tool Development

ICR 200910-0920-004

OMB: 0920-0840

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form
New
Form
New
Form
New
Form
New
Form
New
Form
New
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New
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Supplementary Document
2010-01-14
Supplementary Document
2009-09-21
Supplementary Document
2009-09-08
Supplementary Document
2009-09-08
Supporting Statement A
2010-01-14
IC Document Collections
IC ID
Document
Title
Status
205155 New
203775 New
201871 New
201422 New
201009 New
200047 New
198960 New
198793 New
198250 New
195746 New
194859 New
193928 New
193547 New
192789 New
ICR Details
0920-0840 200910-0920-004
Historical Active
HHS/CDC
Formative Research and Tool Development
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/15/2010
Retrieve Notice of Action (NOA) 10/16/2009
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
01/31/2013 36 Months From Approved
121,800 0 0
46,516 0 0
0 0 0

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.

US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  74 FR 10591 03/11/2009
74 FR 46199 09/08/2009
Yes

14
IC Title Form No. Form Name
MARI - Empowering Latinas to Lash Out Against AIDS (ELLAS) none, none, none, none Screener ,   Group Interview ,   Survey of Individual ,   Health Care Provider Interview
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
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
Evaluation of Rapid HIV Self-Testing: Qualitative and User Proficiency Assessments
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
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
Usability Study of Medscape's Technology-based Panel none, none Screener ,   Questionnaire
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
Local Needs Assessment of Program Collaboration and Service Integration Among Infectious Disease Prevention Providers for Persons Who Use Drugs Illicitly
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 ,   Adolescent survey - Family and Cultural Impact ,   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
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
Field Assessment of a Comprehensive Manual for Hepatitis C Counseling and Testing none, none, none Recruitment Script ,   Interview ,   Check-in Questions
Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation - Spanish version none, none Eligibility screener - Spanish version ,   Baseline survey - Spanish version
Assessing the Accuracy of Self-Report of HIV Testing Behavior none, none, none Medical Record Abstraction ,   Consent Form ,   Patient Survey

  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
Yes
Miscellaneous Actions
No
This is a new generic data collection.

$574,500
No
No
Uncollected
Uncollected
No
Uncollected
Maryam Daneshvar 4046394604

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/16/2009


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