Information Collection

Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM

IC 201422 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⚠️ Notice: This information collection may be referencing outdated material.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
Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM	Form
HCV Testing - Denver screener Att_5a_Denver AlertHealth Screening and Contact Form 02222012.doc	Form
Recruitment - 1a Screener Att 1a_Eligibility Screener_Focus Group.docx	Form
HCV Testing - Focus Group Guide Att_1a_Interview and Focus Group Guide.docx	Form and Instruction
HCV Testing - Screener Att_5b_Community Health Awareness Group Screening and Contact Form.doc	Form
Recruitment - 1b Focus Group Interview Att 1b_Focus Group Interview.docx	Form
Recruitment - 1c Screener Att 1c Eligibility Screener_Web-based survey.docx	Form
Recruitment - 1d Web Survey Att 1d Web-based survey.docx	Form
Recruitment - 3a Spanish Screener Att 3a Eligibility Screener (Spanish).docx	Form
Recruitment - 3b Spanish Survey Att 3b Behavioral Assessment Survey (Spanish).docx	Form
SupportinStatement A.docx HCV Testing - Supporting Statement A	IC Document
Supporting Statement - Part A.docx Recruitment - Supporting Statement A	IC Document
Att_4b_Local IRB Approval - Wayne State Univ IRB.pdf HCV Testing - 4b MI IRB	IC Document
Att_4a_Local IRB Approval - Colorado IRB.pdf HIV Testing - 4a CO IRB	IC Document
Att_2c_Staff and Client Interview and Focus Group Information Sheet.doc HIV Testing - 2c - Info Sheet	IC Document
Att_2a_Staff Interview and Focus Group Consent 02222012.doc HIV Testing - 2a Staff Consent	IC Document
Att_2b_Client Interview and Focus Group Consent 02222012.doc HCV Testing - 2b Client Consent	IC Document
Att_3b_Fact Sheet Living with Chronic Hepatitis C.doc HCV Testing - 3b Fact sheet	IC Document
Att_3a_Fact Sheet Info about Testing Hep C.doc HCV Testing - 3a Fact Sheet	IC Document
Supporting Statement - Part B.docx Recruitment - Supporting Statement B	IC Document
Att 2a Consent_focus group.docx Recruitment - 2a Consent	IC Document
Att 2b_Consent_web-based survey.docx Recruitment - 2b Web Consent	IC Document
Att 1h Screen Shots of Survey.pdf Recruitment - Survey screenshots	IC Document
Att 3 Emory IRB Approval Letter.pdf Recruitment - 3 IRB Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Demonstration Project of HCV Rapid Testing in HIV Testing Settings and Development of Recruitment Strategies for the Web-based HIV Behavioral Survey among MSM

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	HCV Testing - Denver screener	Att_5a_Denver AlertHealth Screening and Contact Form 02222012.doc	No	No	Paper Only
Form	none	Recruitment - 1a Screener	Att 1a_Eligibility Screener_Focus Group.docx	Yes	Yes	Fillable Fileable
Form and Instruction	none	HCV Testing - Focus Group Guide	Att_1a_Interview and Focus Group Guide.docx	No	No	Paper Only
Form	none	HCV Testing - Screener	Att_5b_Community Health Awareness Group Screening and Contact Form.doc	No	No	Paper Only
Form	none	Recruitment - 1b Focus Group Interview	Att 1b_Focus Group Interview.docx	Yes	Yes	Fillable Fileable
Form	none	Recruitment - 1c Screener	Att 1c Eligibility Screener_Web-based survey.docx	Yes	Yes	Fillable Fileable
Form	none	Recruitment - 1d Web Survey	Att 1d Web-based survey.docx	Yes	Yes	Fillable Fileable
Form	none	Recruitment - 3a Spanish Screener	Att 3a Eligibility Screener (Spanish).docx	Yes	Yes	Fillable Fileable
Form	none	Recruitment - 3b Spanish Survey	Att 3b Behavioral Assessment Survey (Spanish).docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,156

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

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	15,156	0	0	0	0	0
Annual IC Time Burden (Hours)	2,104	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
HCV Testing - Supporting Statement A	SupportinStatement A.docx	02/29/2012
Recruitment - Supporting Statement A	Supporting Statement - Part A.docx	02/29/2012
HCV Testing - 4b MI IRB	Att_4b_Local IRB Approval - Wayne State Univ IRB.pdf	02/29/2012
HIV Testing - 4a CO IRB	Att_4a_Local IRB Approval - Colorado IRB.pdf	02/29/2012
HIV Testing - 2c - Info Sheet	Att_2c_Staff and Client Interview and Focus Group Information Sheet.doc	02/29/2012
HIV Testing - 2a Staff Consent	Att_2a_Staff Interview and Focus Group Consent 02222012.doc	02/29/2012
HCV Testing - 2b Client Consent	Att_2b_Client Interview and Focus Group Consent 02222012.doc	02/29/2012
HCV Testing - 3b Fact sheet	Att_3b_Fact Sheet Living with Chronic Hepatitis C.doc	02/29/2012
HCV Testing - 3a Fact Sheet	Att_3a_Fact Sheet Info about Testing Hep C.doc	02/29/2012
Recruitment - Supporting Statement B	Supporting Statement - Part B.docx	02/29/2012
Recruitment - 2a Consent	Att 2a Consent_focus group.docx	02/29/2012
Recruitment - 2b Web Consent	Att 2b_Consent_web-based survey.docx	02/29/2012
Recruitment - Survey screenshots	Att 1h Screen Shots of Survey.pdf	02/29/2012
Recruitment - 3 IRB Letter	Att 3 Emory IRB Approval Letter.pdf	02/29/2012

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