Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3c Focus Groups Guide	Form and Instruction	Modified	Available
Form 3a Screener for Focus Groups	Form and Instruction	Modified	Available
Form 3a One-on-One Surveys	Form and Instruction	Modified	Available
Form 3a Screener for One-on-One Surveys	Form and Instruction	Modified	Available
Form 3a One-on-One Interview Guide	Form and Instruction	Modified	Repair queued
Form 3a Screener for One-on-One Interviews	Form and Instruction	Modified	Available
Justification for change to OMB.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2010-11-08	Available
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
0920-0869_Local IRB approval.Phase 2 One-on-One Survey.docx	Supplementary Document	Uploaded 2010-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194005	Focus Groups Guide	Form and Instruction	Modified
194004	Screener for Focus Groups	Form and Instruction	Modified
194003	One-on-One Surveys	Form and Instruction	Modified
194002	Screener for One-on-One Surveys	Form and Instruction	Modified
194001	One-on-One Interview Guide	Form and Instruction	Modified
194000	Screener for One-on-One Interviews	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0869	ICR Reference No: 201011-0920-007
Status: Historical Active	Previous ICR Reference No: 201007-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/29/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	10/31/2012	10/31/2012
Responses	664	0	664
Time Burden (Hours)	265	0	265
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the proposed study is to elicit attitudes about HIV testing among a community-based sample of non-Hispanic black, heterosexual men, ages 18-25, who were recently arrested and/or recently released from jail/prison. The study will develop culturally-tailored and gender-specific educational materials that promote HIV testing among this population and will occur in 3 phases. In Phase 1, local investigators will conduct qualitative interviews with 20 non-Hispanic black, heterosexual men, ages 18-25, who were recently arrested and/or recently released from jail/prison and meet screening criteria. The interviews will identify their attitudes towards HIV testing, socio-cultural norms, and perceived behavioral control factors that influence HIV testing. During Phase 2, the results from Phase I will be used to identify variables for a survey that will examine attitudes towards HIV testing, socio-cultural norms, and perceived behavioral control factors to HIV testing intentions and behaviors. This brief survey will include 250 non-Hispanic black heterosexual men, ages 18-25, who meet screening criteria. During Phase 3, using Phase 1 and 2 results, educational materials promoting HIV testing among 24 non-Hispanic black heterosexual men will be developed and pilot tested in focus groups of young black men who meet screening criteria to evaluate the acceptability of the materials.

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Authorizing Statute(s): PL: Pub.L. 42 - 241 301 Name of Law: Public Health Service Act
   PL: Pub.L. 42 - 241 308 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

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
Focus Groups Guide	3a, 3c, 3d, 3e	Screening Tool ,   Screener for One-on-One Surveys ,   Survey Instruments ,   Screener for Focus Groups
One-on-One Interview Guide	3a	Screening Tool
One-on-One Surveys	3a, 3c, none	Screening Tool ,   Screener for One-on-One Surveys ,   Survey (attachment 3d)
Screener for Focus Groups	3a, 3c, 3d, 3e	Screening Tool ,   Screener for One-on-One Surveys ,   Survey Instruments ,   Screener for Focus Groups
Screener for One-on-One Interviews	3a	Screening Tool
Screener for One-on-One Surveys	3a, 3c	Screening Tool ,   Screener for One-on-One Surveys

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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	664	664	0	0	0	0
Annual Time Burden (Hours)	265	265	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $299,826

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? Yes

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: 11/29/2010

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