Information Collection

Development of a Motion Comic for HIV/STI Prevention among Young People

IC 198793 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Development of a Motion Comic for HIV/STI Prevention among Young People	Form
Study screener Att_1a_Study Screener.docx	Form
Phase 1 focus group guide Att_1b_Phase 1 Focus Group Modertor Guide.docx	Form and Instruction
Phase 3 focus group guide Att_1d_Phase 3 Focus Group Modertor Guide.docx	Form and Instruction
Phase 2 focus group guide Att_1c_Phase 2 Focus Group Modertor Guide.docx	Form and Instruction
Pre-test survey Att_1e_Participant Pre-Test Survey.docx	Form
Post-test Survey Att_1f_Participant Post-Test Survey.docx	Form
Att_2a_Adult Consent.docx Adult consent	IC Document
Att_2b_Adolescent Parent Consent.docx Parent consent	IC Document
Att_2c_Adolescent Assent.docx Adolescent assent	IC Document
Att_3a_CDC IRB Approval.docx IRB approval	IC Document
Att_4a_Study Recruitment Flyer.docx Recruitment flyer	IC Document
Att_4b_Recruitment Script.docx Recruitment script	IC Document
SS_Part A_ Motion Comic 27JULY2011.docx Supporting Statement A	IC Document
SS_Part B - 8.8.2011.docx Supporting Statement B	IC Document

IC Title:

Development of a Motion Comic for HIV/STI Prevention among Young People

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	Study screener	Att_1a_Study Screener.docx	No	No	Paper Only
Form and Instruction	none	Phase 1 focus group guide	Att_1b_Phase 1 Focus Group Modertor Guide.docx	No	No	Paper Only
Form and Instruction	none	Phase 3 focus group guide	Att_1d_Phase 3 Focus Group Modertor Guide.docx	No	No	Paper Only
Form and Instruction	none	Phase 2 focus group guide	Att_1c_Phase 2 Focus Group Modertor Guide.docx	No	No	Paper Only
Form	none	Pre-test survey	Att_1e_Participant Pre-Test Survey.docx	Yes	Yes	Fillable Fileable
Form	none	Post-test Survey	Att_1f_Participant Post-Test Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 780

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

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	780	0	0	0	0	0
Annual IC Time Burden (Hours)	545	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
Adult consent	Att_2a_Adult Consent.docx	08/04/2011
Parent consent	Att_2b_Adolescent Parent Consent.docx	08/04/2011
Adolescent assent	Att_2c_Adolescent Assent.docx	08/04/2011
IRB approval	Att_3a_CDC IRB Approval.docx	08/04/2011
Recruitment flyer	Att_4a_Study Recruitment Flyer.docx	08/04/2011
Recruitment script	Att_4b_Recruitment Script.docx	08/04/2011
Supporting Statement A	SS_Part A_ Motion Comic 27JULY2011.docx	08/08/2011
Supporting Statement B	SS_Part B - 8.8.2011.docx	08/08/2011

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