OMB
.report
Search
Screener for Focus Groups
Promoting HIV Testing among Low Income Heterosexual Young Adult Black Men
OMB: 0920-0869
IC ID: 194004
OMB.report
HHS/CDC
OMB 0920-0869
ICR 201011-0920-007
IC 194004
( )
Documents and Forms
Document Name
Document Type
Form 3a
Screener for Focus Groups
Form and Instruction
0920-09CJ_att3b_One-on-One Interview Guide OADS.06162010.docx
Other-Interview Guide
3a Screening Tool
0920-09CJ_att3a_Screener for One-on-One Interviews.OADS.docx
Form and Instruction
3c Screener for One-on-One Surveys
0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.OADS.docx
Form and Instruction
3d Survey Instruments
0920-09CJ_att3d_Phase 2 One-on-One Surveys.OADS.docx
Form
3e Screener for Focus Groups
0920-09CJ_att3e_Phase 3 Screener for Focus Groups.OADS.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Screener for Focus Groups
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Form and Instruction
3a
Screening Tool
0920-09CJ_att3a_Screener for One-on-One Interviews.OADS.docx
Yes
Yes
Fillable Fileable
Other-Interview Guide
0920-09CJ_att3b_One-on-One Interview Guide OADS.06162010.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3c
Screener for One-on-One Surveys
0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.OADS.docx
Yes
Yes
Fillable Fileable
Form
3d
Survey Instruments
0920-09CJ_att3d_Phase 2 One-on-One Surveys.OADS.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3e
Screener for Focus Groups
0920-09CJ_att3e_Phase 3 Screener for Focus Groups.OADS.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
40
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
40
0
0
0
0
40
Annual IC Time Burden (Hours)
7
0
0
0
0
7
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.