Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3b Quantiative Survey	Form	New	Available
Form no number A-CASI	Form	New	Available
Form no number Qualitative Interview Guide	Form	New	Available
Form 3b Qualitative Survey Measures	Form	New	Available
Form no number ACASI Quantitative Survey	Form	New	Available
Form 3a Screening Questionaire 11_01-2010	Form	New	Available
Form No number Screening Questionnaire	Form	New	Available
Attachment 5a_Recruitment Card and Script 11012010.docx	Supplementary Document	Uploaded 2010-11-02	Available
Attachment 4a_Participant Consent Form 11012010.docx	Supplementary Document	Uploaded 2010-11-02	Available
Attachment 3b_Quantitative Survey Measures11012010.docx	Supplementary Document	Uploaded 2010-11-02	Available
Attachment 3d_3 mth Follow-up Qualitative Interview Guide 11012010.docx	Supplementary Document	Uploaded 2010-11-02	Available
Attachment 3a_Screening Questionnaires 11012010.docx	Supplementary Document	Uploaded 2010-11-02	Available
SS_Part B.06162010.docx	Supporting Statement B	Uploaded 2010-07-27	Available
Attachment 6a_local IRB 2011.pdf	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 5d_Contact Tracking Log.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 5c_Participant Contact Template.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 5b_Locator Form.06162010.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 5a_Recruitment Card and Script.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 4b_Audio Recording Consent.07092010.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 4a_Participant Consent Form.07092010.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 2 Published 60 day2010-9606.pdf	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 1_Legislative Authority.06162010.docx	Supplementary Document	Uploaded 2010-07-27	Available
Attachment 7b_NYS HIV Testing Flowchart.pdf	Supplementary Document	Uploaded 2010-08-03	Available
SS Part A 07092010.docx	Supporting Statement A	Uploaded 2010-07-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194319	Interview 3-Month Follow-up	Other-Interview Guidelines	New
194318	A-CASI 3-Month Follow-up	Form	New	Quantiative Survey
194318	A-CASI 3-Month Follow-up	Form	New	A-CASI
194317	HIV Testing and Counseling Baseline & 3-Month Follow-up	Other-Cover Page	New
194316	Interview Baseline	Form	New	Qualitative Interview Guide
194315	A-CASI Baseline	Form	New	Qualitative Survey Measures
194315	A-CASI Baseline	Form	New	ACASI Quantitative Survey
194314	Screening Questionnaire	Form	New	Screening Questionaire 11_01-2010
194314	Screening Questionnaire	Form	New	Screening Questionnaire

ICR Details

OMB Control No: 0920-0872	ICR Reference No: 201008-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/29/2010
	Date Received in OIRA: 08/19/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	24 Months From Approved
Responses	2,350	0	0
Time Burden (Hours)	1,338	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention request approval to assess how interpersonal communication within Black men who have sex with men (BMSM) social networks may be related to risk for HIV Infection and attitudes towards HIV testing. This study will provide important epidemiologic information, useful for the development of HIV prevention interventions for BMSM.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 21630	04/26/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 43988	07/27/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Screening Questionnaire	No number, 3a	Screening Questionnaire ,   Screening Questionaire 11_01-2010
A-CASI Baseline	no number, 3b	ACASI Quantitative Survey ,   Qualitative Survey Measures
Interview Baseline	no number	Qualitative Interview Guide
HIV Testing and Counseling Baseline & 3-Month Follow-up
A-CASI 3-Month Follow-up	no number, 3b	A-CASI ,   Quantiative Survey
Interview 3-Month Follow-up

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ICR Summary of Burden

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	2,350	0	0	2,350	0	0
Annual Time Burden (Hours)	1,338	0	0	1,338	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $366,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/19/2010

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