HIV Testing and Counseling Baseline & 3-Month Follow-up

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

Documents and Forms

Document Name Document Type
Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc Other-Cover Page
Attachment 7a_NYS Informed Consent HIV Testing.pdf Other-Informed Consent
Attachment 7b_NYS HIV Testing Flowchart.pdf Process Flowchart IC Document

Information Collection (IC) Details

IC Title:	HIV Testing and Counseling Baseline & 3-Month Follow-up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Page			Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc		Yes	No	Fillable Fileable
Other-Informed Consent			Attachment 7a_NYS Informed Consent HIV Testing.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Process Flowchart	Attachment 7b_NYS HIV Testing Flowchart.pdf	08/03/2010

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