Testing Brief Messages for Black and Latino MSM

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Testing Brief Messages for Black and Latino MSM Form
Eligibility Screener - English Att 3 Eligib Screener.English.Webscreen.pdf Form
Eligibility Screener -Spanish Att 5 Eligib Screener.Spanish.Webscreen.pdf Form
Messages and Outcomes Att 11 Messages and Outcomes.Eng.Webscreen.pdf Form
Messages and Outcomes - Spanish Att 13 Messages and Outcomes.Spanish.Webscreen.pdf Form
Assessment - English Att 15 Assessment.English.WebScreen.pdf Form
Assessment - Spanish Att 17 Assessment.Spanish.WebScreen.pdf Form
SS Part A.docx Supporting Statement A IC Document
SS Part B.docx Supporting Statement B IC Document
Att 6 Info for Participants.English.doc Information Sheet - English IC Document
att 7 Info for Participants.Eng.Webscreen.pdf Information Sheet - English screenshot IC Document
Att 8 Info for Participants.Spanish.docx Information Sheet - Spanish IC Document
Att 9 Info for Participants.Spanish.Webscreen.pdf Information Sheet - Spanish screenshot IC Document
Att 2 Eligib Screener.English.docx Eligibility Screener - English word IC Document
Att 4 Eligib Screener.Spanish.docx Eligibility Screener - Spanish word IC Document
Att 10 Messages and Outcomes.English.docx Messages - English word IC Document
Att 12 Messages and Outcomes.Spanish.docx Messages - Spanish word IC Document
Att 14 Assessment.English.docx Assessment - English word IC Document
Att 16 Assessment.Spanish.docx Assessment - Spanish word IC Document
Att 18 Recruitment Materials.pdf Recruitment Materials IC Document

Information Collection (IC) Details

IC Title:	Testing Brief Messages for Black and Latino MSM	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Eligibility Screener - English	Att 3 Eligib Screener.English.Webscreen.pdf	Yes	Yes	Fillable Fileable
Form	none	Eligibility Screener -Spanish	Att 5 Eligib Screener.Spanish.Webscreen.pdf	Yes	Yes	Fillable Fileable
Form	none	Messages and Outcomes	Att 11 Messages and Outcomes.Eng.Webscreen.pdf	Yes	Yes	Fillable Fileable
Form	none	Messages and Outcomes - Spanish	Att 13 Messages and Outcomes.Spanish.Webscreen.pdf	Yes	Yes	Fillable Fileable
Form	none	Assessment - English	Att 15 Assessment.English.WebScreen.pdf	Yes	Yes	Fillable Fileable
Form	none	Assessment - Spanish	Att 17 Assessment.Spanish.WebScreen.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,780	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,780	3,780
Annual IC Time Burden (Hours)	1,455	1,455
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SS Part A.docx	05/01/2014
Supporting Statement B	SS Part B.docx	05/01/2014
Information Sheet - English	Att 6 Info for Participants.English.doc	05/01/2014
Information Sheet - English screenshot	att 7 Info for Participants.Eng.Webscreen.pdf	05/01/2014
Information Sheet - Spanish	Att 8 Info for Participants.Spanish.docx	05/01/2014
Information Sheet - Spanish screenshot	Att 9 Info for Participants.Spanish.Webscreen.pdf	05/01/2014
Eligibility Screener - English word	Att 2 Eligib Screener.English.docx	05/01/2014
Eligibility Screener - Spanish word	Att 4 Eligib Screener.Spanish.docx	05/01/2014
Messages - English word	Att 10 Messages and Outcomes.English.docx	05/01/2014
Messages - Spanish word	Att 12 Messages and Outcomes.Spanish.docx	05/01/2014
Assessment - English word	Att 14 Assessment.English.docx	05/01/2014
Assessment - Spanish word	Att 16 Assessment.Spanish.docx	05/01/2014
Recruitment Materials	Att 18 Recruitment Materials.pdf	05/01/2014

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