Information Collection

Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment

IC 193928 under ICR 200910-0920-004 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment Form
Screener Attachment 1a_Screening and Contact Info Forms.06262010.docx Form
ACASI survey Attachment 1b_ACASI Survey.06262010.docx Form
Web-based sex diary Attachment 1c_Web-based Sex Diary.06262010.docx Form
In-depth interview Attachment 1d_In-depth Interviews.docx Form
SS Part A.06262010.docx Supporting statement A IC Document
SS Part B.docx Supporting statement B IC Document
Attachment 2_Consent Forms.06262010.docx Attachment 2 - Consent forms IC Document
Attachment 4_Recruitment Materials and Website Screenshots.06262010.docx Attachment 4 - Recruitment materials IC Document
Attachment 3a_local IRBapproval.April 2011.pdf Attachment 3 - IRB approval IC Document
Attachment 5_Certificate of Confidentiality.pdf Attachment 5 - Certificate of confidentiality IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sexual risk-taking among young black men who have sex with men: exploring the social and situational contexts of HIV risk, prevention and treatment	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screener	Attachment 1a_Screening and Contact Info Forms.06262010.docx	Yes	Yes	Fillable Fileable
Form	none	ACASI survey	Attachment 1b_ACASI Survey.06262010.docx	Yes	Yes	Fillable Fileable
Form	none	Web-based sex diary	Attachment 1c_Web-based Sex Diary.06262010.docx	Yes	Yes	Fillable Fileable
Form	none	In-depth interview	Attachment 1d_In-depth Interviews.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 730	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	1,780	0	0	0	0	0
Annual IC Time Burden (Hours)	745	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting statement A	SS Part A.06262010.docx	07/14/2010
Supporting statement B	SS Part B.docx	07/14/2010
Attachment 2 - Consent forms	Attachment 2_Consent Forms.06262010.docx	07/14/2010
Attachment 4 - Recruitment materials	Attachment 4_Recruitment Materials and Website Screenshots.06262010.docx	07/14/2010
Attachment 3 - IRB approval	Attachment 3a_local IRBapproval.April 2011.pdf	07/14/2010
Attachment 5 - Certificate of confidentiality	Attachment 5_Certificate of Confidentiality.pdf	07/14/2010

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