Information Collection Request

Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men

ICR 201007-0920-010 · OMB 0920-0869 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 3e 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010 Form and Instruction New Available
Form 3c 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010 Form and Instruction New Available
Form 3e Screener for Focus Groups Form and Instruction New Available
Form 3d Survey Instruments Form New Available
Form 3c Screener for One-on-One Surveys Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1 Form and Instruction New Available
Form 3e 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010. Form and Instruction New Available
Form 3c 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010 Form and Instruction New Available
Form 3e Screener for Focus Groups Form and Instruction New Available
Form 3d Survey Instruments Form New Available
Form 3c Screener for One-on-One Surveys Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010- Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1 Form and Instruction New Available
Form 3c Screener for On-on-One Surveys 10062010 Form and Instruction New Available
Form 3d Survey Instruments Form New Available
Form 3c Screener for One-on-One Surveys Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1 Form and Instruction New Available
Form 3c 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010 Form and Instruction New Available
Form 3c Screener for One-on-One Surveys Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1 Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1 Form and Instruction New Available
Form 3a Screening Tool Form and Instruction New Available
0920-09CJ_SS_SectB OADS.06162010.docx Supporting Statement B Uploaded 2010-06-29 Available
0920-09CJ_att7.HIV Educational Packet.docx Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att6a_local IRB approval.2011.pdf Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att6b_NCHHSTP Project Determination.pdf Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att5f_Phase 3 Focus Groups Reminders.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att5e_Phase 3 Focus Group Recruitment Script.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att5d_Phase 2 Quantitative Survey Recruitment Script.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att5c_Phase 1 Qualitative Interview Reminders.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att5b_Phase 1 Qualitative Interview Recruitment Flyer.OADS.docx Supplementary Document Uploaded 2010-06-29 Repair queued
0920-09CJ_att5a_Phase 1 Qualitative Interview Recruitment Script.OADS.docx Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att4c_Phase 3 Focus Groups Consent.OADS.docx Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att4b_Phase2 Quantitative Survey Consent.OADS.docx Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att4a_Phase 1 Qualitative Interview Consent.OADS.docx Supplementary Document Uploaded 2010-06-29 Repair queued
0920-09CJ_att3I_Phase 3 Focus Groups Screening Script.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att3h_Phase 2 Quantitative Survey Screening Script.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_att3g_Phase 1 Qualitative Interview Screening Script.doc Supplementary Document Uploaded 2010-06-29 Available
0920-09CJ_SS_SectA.10062010.docx Supporting Statement A Uploaded 2010-10-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
194005 Focus Groups Guide Form and Instruction New0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010
194005 Focus Groups Guide Form and Instruction New0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010
194005 Focus Groups Guide Form and Instruction NewScreener for Focus Groups
194005 Focus Groups Guide Form NewSurvey Instruments
194005 Focus Groups Guide Form and Instruction NewScreener for One-on-One Surveys
194005 Focus Groups Guide Other-Interview Guide New
194005 Focus Groups Guide Form and Instruction NewScreening Tool
194005 Focus Groups Guide Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1
194004 Screener for Focus Groups Form and Instruction New0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010.
194004 Screener for Focus Groups Form and Instruction New0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010
194004 Screener for Focus Groups Form and Instruction NewScreener for Focus Groups
194004 Screener for Focus Groups Form NewSurvey Instruments
194004 Screener for Focus Groups Form and Instruction NewScreener for One-on-One Surveys
194004 Screener for Focus Groups Other-Interview Guide New
194004 Screener for Focus Groups Form and Instruction NewScreening Tool
194004 Screener for Focus Groups Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-
194003 One-on-One Surveys Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1
194003 One-on-One Surveys Form and Instruction NewScreener for On-on-One Surveys 10062010
194003 One-on-One Surveys Form NewSurvey Instruments
194003 One-on-One Surveys Form and Instruction NewScreener for One-on-One Surveys
194003 One-on-One Surveys Other-Interview Guide New
194003 One-on-One Surveys Form and Instruction NewScreening Tool
194002 Screener for One-on-One Surveys Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1
194002 Screener for One-on-One Surveys Form and Instruction New0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010
194002 Screener for One-on-One Surveys Form and Instruction NewScreener for One-on-One Surveys
194002 Screener for One-on-One Surveys Other-Interview Guide New
194002 Screener for One-on-One Surveys Form and Instruction NewScreening Tool
194001 One-on-One Interview Guide Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1
194001 One-on-One Interview Guide Other-Interview Guide att3b 10062010 New
194001 One-on-One Interview Guide Form and Instruction NewScreening Tool
194000 Screener for One-on-One Interviews Form and Instruction New0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1
194000 Screener for One-on-One Interviews Form and Instruction NewScreening Tool

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2012 24 Months From Approved
664 0 0
265 0 0
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
Focus Groups Guide 3c, 3e, 3a, 3a, 3c, 3d, 3e ,   ,   ,   ,   ,   ,  
One-on-One Interview Guide 3a, 3a ,  
One-on-One Surveys 3a, 3c, 3c, 3d, 3a ,   ,   ,   ,  
Screener for Focus Groups 3c, 3e, 3a, 3a, 3c, 3d, 3e ,   ,   ,   ,   ,   ,  
Screener for One-on-One Interviews 3a, 3a ,  
Screener for One-on-One Surveys 3c, 3a, 3a, 3c ,   ,   ,  

table that charts list of burden
  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 664 0 0 664 0 0
Annual Time Burden (Hours) 265 0 0 265 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No