Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Partner Services Paper and Pencil Questionnaire	Form	Modified	Available
PIC Paper and Pencil Questionnaire	Form	Modified	Available
Emergency Dept Paper and Pencil Questionnaire	Form	Modified	Available
Prevention is Care Screener	Form	Modified	Available
Patner Services Screener	Form	Modified	Repair queued
Emergency Dept. Routine HIV Testing Screener	Form	Modified	Available
Partner Services - Material Testing Interview	Form	Modified	Available
Partner Services - Concept Testing Interview	Form	Modified	Available
Prevention is Care Interview	Form	Modified	Available
Emergency Department HIV Testing Interview	Form	Modified	Available
15 Section B - Statistical Methods 03-16-11.docx	Supporting Statement B	Uploaded 2011-03-23	Available
A8_Recruitment Agreement 2-24-11.doc	Supplementary Document	Uploaded 2011-03-23	Available
0775 60-day Pub12-3-2010.pdf	Supplementary Document	Uploaded 2011-03-23	Available
Attach1 Authorizing Legislation-Provider Extension.docx	Supplementary Document	Uploaded 2011-03-23	Repair queued
A5c_Consent Forms-PS_3-1-11.doc	Supplementary Document	Uploaded 2011-03-23	Available
A5c_Consent Forms-PS_3-1-11.doc	Supplementary Document	Uploaded 2011-03-23	Available
A5b_Consent Forms-PIC_3-1-11.doc	Supplementary Document	Uploaded 2011-03-23	Available
A5a_Consent Forms-RT_3-1-11.doc	Supplementary Document	Uploaded 2011-03-23	Available
14 Section A - Justification_Extension Request 03-02-01.docx	Supporting Statement A	Uploaded 2011-03-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183191	Partner Services Paper and Pencil Questionnaire	Form	Modified	Partner Services Paper and Pencil Questionnaire
183190	Prevention Is Care (PIC) Paper and Pencil Questionnaire	Form	Modified	PIC Paper and Pencil Questionnaire
183189	Emergency Departments Paper and Pencil Questionnaire	Form	Modified	Emergency Dept Paper and Pencil Questionnaire
183188	Prevention Is Care (PIC) Study Screener	Form	Modified	Prevention is Care Screener
183187	Partner Services Study Screener	Form	Modified	Patner Services Screener
183186	Emergency Departments Study Screener	Form	Modified	Emergency Dept. Routine HIV Testing Screener
183185	HIV Partner Services Material Testing Interview	Form	Modified	Partner Services - Material Testing Interview
183184	HIV Partner Services Concept Testing Interview	Form	Modified	Partner Services - Concept Testing Interview
183183	HIV Partner Services Exploratory Research	Other-WORD	Removed
183182	Prevention Is Care (PIC) Material Testing Interview	Form	Modified	Prevention is Care Interview
183181	Emergency Departments Material Testing Interview	Form	Modified	Emergency Department HIV Testing Interview

ICR Details

OMB Control No: 0920-0775	ICR Reference No: 201104-0920-002
Status: Historical Active	Previous ICR Reference No: 200712-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/10/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/08/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	05/31/2011
Responses	293	0	476
Time Burden (Hours)	117	0	194
Cost Burden (Dollars)	0	0	0

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Abstract: This project involves formative research to inform the development of 3 CDC-sponsored social marketing campaigns: 1) Social Marketing Campaigns to Make HIV Testing a Routine Part of Medical Care for Emergency Medicine Physicians (Routine HIV Testing); 2) Prevention Is Care (PIC); and 3) Partner Services (Partner Services). Activities include conducting interviews to test creative materials with groups of emergency medicine physicians for Routine HIV Testing and, PCP and Infectious Disease Specialists for PIC and Partner Services.

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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 75474	12/03/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 16629	03/24/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Partner Services Study Screener	none	Patner Services Screener
Emergency Departments Material Testing Interview	none	Emergency Department HIV Testing Interview
Emergency Departments Paper and Pencil Questionnaire	none	Emergency Dept Paper and Pencil Questionnaire
Emergency Departments Study Screener	none	Emergency Dept. Routine HIV Testing Screener
HIV Partner Services Concept Testing Interview	none	Partner Services - Concept Testing Interview
HIV Partner Services Exploratory Research
HIV Partner Services Material Testing Interview	none	Partner Services - Material Testing Interview
Partner Services Paper and Pencil Questionnaire	none	Partner Services Paper and Pencil Questionnaire
Prevention Is Care (PIC) Material Testing Interview	none	Prevention is Care Interview
Prevention Is Care (PIC) Paper and Pencil Questionnaire	none	PIC Paper and Pencil Questionnaire
Prevention Is Care (PIC) Study Screener	none	Prevention is Care Screener

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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	293	476	0	-183	0	0
Annual Time Burden (Hours)	117	194	0	-77	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The program requests an extension to complete the 82 remaining interviews for this project; all exploratory research has been completed.

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Annual Cost to Federal Government: $293,652

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: 04/08/2011

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