3d Survey Instruments

“Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men”

0920-XXXX

Attachment 3d. Phase 2 One-on-One Surveys

Form Approved

OMB No. 0920-XXXX

Expiration Date XX/XX/20XX

“Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men”

One-on-One Survey

Public reporting burden of this collection of information is estimated to average 30 minutes per response,, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-XXXX)

The Phase Two survey will be developed based on results from Phase One interviews. Variables that will be measured are listed below:

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