Information Collection

Informing the Development of Mobile Apps for HIV Prevention, Treatment & Care

IC 207103 under ICR 201301-0920-010 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Informing the Development of Mobile Apps for HIV Prevention, Treatment & Care	Form
Screener Att_2a_Screener_PLWH.docx	Form
Screener High Risk Att_2b_Screener High-Risk MSM.docx	Form
Screener HIV Providers Att_2c_ Screener HIV Providers.docx	Form
PLWH Guide Att_2d_ModGuide PLWH.docx	Form
PLWH Guide Spanish Att_2e_ModGuide PLWH_SPANISH.docx	Form
High Risk Guide Att_2f_ModGuide High Risk MSM.docx	Form
form High Risk Guide Spanish Att_2g_ModGuide High Risk MSM_SPANISH.docx	Form
HC Providers Guide Att_2h_ModGuide HIV Healthcare Providers.docx	Form
Focus Group Assessment Att_2i_FocusGrp Assessment 1 English.docx	Form
Focus Group Assessment Spanish Att_2j_FocusGrp Assessment #2 Spanish.docx	Form
End User Survey Att_2k_End User Survey.docx	Form
Consent PLWH & High Risk Att_3a_Consent form PLWH & High Risk MSM.docx	Form
Consent PLWH & High Risk Spanish Att_3b_Consent form PLWH & High Risk MSM_SPANISH.docx	Form
Assent PLWH & High Risk Att_3c_Assent form PLWH & High risk MSM.docx	Form
Consent HC Providers Att_3d_Consent form Healthcare Providers.docx	Form
Usability Consent Att_3e_Usability Consent form.docx	Form
Usability Assent Att_3f_Usability Assent form.docx	Form
Att_1_Auth Legislation.docx Authorizing Legislation	IC Document
Att_4a_Columbia U IRB Letter.pdf IRB Letter	IC Document
SS_ Part B.docx Supporting Statement Part B	IC Document
Att_5a_PLWH Recruitment Flyer.docx PLWH Recruitment Flyer	IC Document
Att_5b_PLWH Recruitment Flyer_SPANISH.docx PLWH Recruit Flyer - Spanish	IC Document
Att_5c_High Risk MSM Recruiment Flyer.docx MSM Recruitment Flyer	IC Document
Att_5d_High Risk MSM Recruiment Flyer_SPANISH.docx MSM Recruit Flyer Spanish	IC Document
Att_5e_Usability Recruitment flyer.docx Usability Recruit Flyer	IC Document
Att_5f_Healthcare Provider Recruitment Flyer.docx HC Provider Recruit Flyer	IC Document
Att_5g_Potential Hueristic Evaluation Letter.docx Potential Evaluation Letter	IC Document
SS_Part Arev.docx Supporting Statement Part A	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Informing the Development of Mobile Apps for HIV Prevention, Treatment & Care

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screener	Att_2a_Screener_PLWH.docx	Yes	No	Fillable Printable
Form	none	Screener High Risk	Att_2b_Screener High-Risk MSM.docx	Yes	No	Fillable Fileable
Form	none	Screener HIV Providers	Att_2c_ Screener HIV Providers.docx	Yes	No	Fillable Printable
Form	none	PLWH Guide	Att_2d_ModGuide PLWH.docx	Yes	No	Fillable Printable
Form	none	PLWH Guide Spanish	Att_2e_ModGuide PLWH_SPANISH.docx	Yes	No	Fillable Fileable
Form	none	High Risk Guide	Att_2f_ModGuide High Risk MSM.docx	Yes	No	Fillable Printable
Form	form	High Risk Guide Spanish	Att_2g_ModGuide High Risk MSM_SPANISH.docx	Yes	No	Fillable Printable
Form	none	HC Providers Guide	Att_2h_ModGuide HIV Healthcare Providers.docx	Yes	No	Fillable Printable
Form	none	Focus Group Assessment	Att_2i_FocusGrp Assessment 1 English.docx	Yes	No	Fillable Printable
Form	none	Focus Group Assessment Spanish	Att_2j_FocusGrp Assessment #2 Spanish.docx	Yes	No	Fillable Printable
Form	none	End User Survey	Att_2k_End User Survey.docx	Yes	No	Fillable Printable
Form	none	Consent PLWH & High Risk	Att_3a_Consent form PLWH & High Risk MSM.docx	Yes	No	Fillable Printable
Form	none	Consent PLWH & High Risk Spanish	Att_3b_Consent form PLWH & High Risk MSM_SPANISH.docx	Yes	No	Fillable Printable
Form	none	Assent PLWH & High Risk	Att_3c_Assent form PLWH & High risk MSM.docx	Yes	No	Fillable Printable
Form	none	Consent HC Providers	Att_3d_Consent form Healthcare Providers.docx	Yes	No	Fillable Printable
Form	none	Usability Consent	Att_3e_Usability Consent form.docx	Yes	No	Fillable Printable
Form	none	Usability Assent	Att_3f_Usability Assent form.docx	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 692

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	692	0	0	0	0	0
Annual IC Time Burden (Hours)	206	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	Att_1_Auth Legislation.docx	05/23/2013
IRB Letter	Att_4a_Columbia U IRB Letter.pdf	05/23/2013
Supporting Statement Part B	SS_ Part B.docx	05/28/2013
PLWH Recruitment Flyer	Att_5a_PLWH Recruitment Flyer.docx	05/27/2013
PLWH Recruit Flyer - Spanish	Att_5b_PLWH Recruitment Flyer_SPANISH.docx	05/27/2013
MSM Recruitment Flyer	Att_5c_High Risk MSM Recruiment Flyer.docx	05/27/2013
MSM Recruit Flyer Spanish	Att_5d_High Risk MSM Recruiment Flyer_SPANISH.docx	05/27/2013
Usability Recruit Flyer	Att_5e_Usability Recruitment flyer.docx	05/27/2013
HC Provider Recruit Flyer	Att_5f_Healthcare Provider Recruitment Flyer.docx	05/27/2013
Potential Evaluation Letter	Att_5g_Potential Hueristic Evaluation Letter.docx	05/28/2013
Supporting Statement Part A	SS_Part Arev.docx	05/28/2013

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