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Federal forms, ICRs, and supporting documents

Information Collection

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

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

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Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL 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

Health Consumer Health and Safety

 

692 0
   
Individuals or Households
 
   0 %

  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

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.