Information Collection Request

Multisite Evaluation of the In Community Spirit Program - Prevention of HIV/AIDS for Native/American Indian and Alaska Native Women Living in Rural and Frontier Indian Country

ICR 201111-0990-002 · OMB 0990-0396 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Attachment D.3 HEAL_Prevention Education Consent_Pretest_030712.doc Supplementary Document Uploaded 2012-06-25 Available
Attachment D.3 HEAL_Prevention Education Consent_Post_030712.doc Supplementary Document Uploaded 2012-06-25 Available
Attachment D.3 HEAL_Prevention Education Consent_followup_030712.doc Supplementary Document Uploaded 2012-06-25 Available
Attachment D.1 Key Informant Interviews Consent Script_Followup030712.doc Supplementary Document Uploaded 2012-06-25 Available
Attachment C_42 USC 241.pdf Supplementary Document Uploaded 2012-06-25 Available
Part B OMB ICS Multisite evaluation In Community Spirit 6 7 12.doc Supporting Statement B Uploaded 2012-06-25 Available
0990-Community Spirit_Attachment D.3 HEAL_Prevention Education Consent.doc Supplementary Document Uploaded 2011-11-02 Available
0990-Community Spirit_Attachment D 2 HEAL_Community Awareness Consent.doc Supplementary Document Uploaded 2011-11-02 Available
Attachment D.1 Key Informant Interviews Consent Script_Baseline030712.doc Supplementary Document Uploaded 2012-06-25 Available
Part A OMB ICS Multisite evaluation of In Community Spirit 062012.doc Supporting Statement A Uploaded 2012-06-25 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
200041 Community Member Other-Survey New
200039 Healthcare support workers Other-Interview Form New
200038 Health Educators Other-Interview Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2015 36 Months From Approved
1,860 0 0
500 0 0
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Health Educators
Healthcare support workers
Community Member

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 1,860 0 0 1,860 0 0
Annual Time Burden (Hours) 500 0 0 500 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No