Information Collection

Understanding Barriers and Facilitators to HIV Prevention, Care, and Treatment

IC 211515 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⚠️ Notice: This information collection may be referencing outdated material.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
Understanding Barriers and Facilitators to HIV Prevention, Care, and Treatment	Form
Provider Demographic Questionnaire Att_2a_Provider Demographic Questionnaire.docx	Form
Provider interview guide Att_2b_Provider InDepth Interview Guide.docx	Form and Instruction
Study screener - English Att_2c_PLWH Study Screener-English.docx	Form
Study screener - Spanish Att_2d_PLWH Study Screener-Spanish.docx	Form
Discordant partners screeners - English Att_2e_HIV-discordant Partners Study Screener-English.docx	Form
Discordant partners screener - Spanish Att_2f_HIV-discordant Partners Study Screener-Spanish.docx	Form
Contact Information - English Att_2g_PLWH Contact Information Form English.docx	Form
Contact Information - Spanish Att_2h_PLWH Contact Information Form Spanish.docx	Form
Discordant partners contact info - English Att_2i_HIV Discordant Partners Contact Information Form English.docx	Form
Discordant partners contact info - Spanish Att_2j_HIV Discordant Partners Contact Information Form Spanish.docx	Form
PLWH interview guide - English Att_2k_PLWH In-Depth Interview Guide-English.docx	Form and Instruction
PLWH interview guide - Spanish Att_2l_PLWH In-Depth Interview Guide-Spanish.docx	Form and Instruction
Discordant partners interview guide - English Att_2m_HIV-discordant Partners In-Depth Interview Guide-English.docx	Form and Instruction
Discordant partners interview guide - Spanish Att_2n_HIV-discordant Partners In-Depth Interview Guide-Spanish.docx	Form and Instruction
Provider info sheet and consent Att_3a_Provider Information Sheet and Consent Form.docx	Form and Instruction
PLWH consent Att_3b_PLWH Consent Form- English.docx	Form and Instruction
PLWH consent - Spanish Att_3c_PLWH Consent Form-Spanish.docx	Form and Instruction
Discordant partner consent - English Att_3d_ HIV-discordant Partners Consent Form- English.docx	Form and Instruction
Discordant partner consent - Spanish Att_3e_HIV-discordant Partners Consent Form- Spanish.docx	Form and Instruction
Supporting Statement A.docx Supporting Statement A	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document
Att_4a_ABT IRB Approval Letter.pdf ABT IRB Approval	IC Document
Att_4b_Emory University IRB Approval Letter.docx Emory IRB Approval	IC Document
Att_5a_Provider Recruitment Script.docx Provider recruitment script	IC Document
Att_5b_PLWH Recruitment Advertisement English.docx PLWH recruitment ads - English	IC Document
Att_5c_PLWH Recruitment Advertisement Spanish.docx PLWH recruitment ads - Spanish	IC Document
Att_5d_PLWH RecruitFlyersEnglish.pdf PLWH Recruitment flyers - English	IC Document
Att_5e_PLWH RecruitFlyersSpanish.pdf PLWH recruitment flyers - Spanish	IC Document
Att_6a_Spanish Translation Certification.pdf Spanish translation certification	IC Document
Att_7a_ABT Data Security Plan.docx ABT data security plan	IC Document
Att_7b_RSS Data Security Plan.docx RSS data security plan	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Understanding Barriers and Facilitators to HIV Prevention, Care, and Treatment

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?	Electronic Capability
Form	none	Provider Demographic Questionnaire	Att_2a_Provider Demographic Questionnaire.docx	No	Paper Only
Form and Instruction	none	Provider interview guide	Att_2b_Provider InDepth Interview Guide.docx	No	Paper Only
Form	none	Study screener - English	Att_2c_PLWH Study Screener-English.docx	No	Paper Only
Form	none	Study screener - Spanish	Att_2d_PLWH Study Screener-Spanish.docx	No	Paper Only
Form	none	Discordant partners screeners - English	Att_2e_HIV-discordant Partners Study Screener-English.docx	No	Paper Only
Form	none	Discordant partners screener - Spanish	Att_2f_HIV-discordant Partners Study Screener-Spanish.docx	No	Paper Only
Form	none	Contact Information - English	Att_2g_PLWH Contact Information Form English.docx	No	Paper Only
Form	none	Contact Information - Spanish	Att_2h_PLWH Contact Information Form Spanish.docx	No	Paper Only
Form	none	Discordant partners contact info - English	Att_2i_HIV Discordant Partners Contact Information Form English.docx	No	Paper Only
Form and Instruction	none	Discordant partner consent - Spanish	Att_3e_HIV-discordant Partners Consent Form- Spanish.docx	No	Paper Only
Form	none	Discordant partners contact info - Spanish	Att_2j_HIV Discordant Partners Contact Information Form Spanish.docx	No	Paper Only
Form and Instruction	none	PLWH interview guide - English	Att_2k_PLWH In-Depth Interview Guide-English.docx	No	Paper Only
Form and Instruction	none	PLWH interview guide - Spanish	Att_2l_PLWH In-Depth Interview Guide-Spanish.docx	No	Paper Only
Form and Instruction	none	Discordant partners interview guide - English	Att_2m_HIV-discordant Partners In-Depth Interview Guide-English.docx	No	Paper Only
Form and Instruction	none	Discordant partners interview guide - Spanish	Att_2n_HIV-discordant Partners In-Depth Interview Guide-Spanish.docx	No	Paper Only
Form and Instruction	none	Provider info sheet and consent	Att_3a_Provider Information Sheet and Consent Form.docx	No	Paper Only
Form and Instruction	none	PLWH consent	Att_3b_PLWH Consent Form- English.docx	No	Paper Only
Form and Instruction	none	PLWH consent - Spanish	Att_3c_PLWH Consent Form-Spanish.docx	No	Paper Only
Form and Instruction	none	Discordant partner consent - English	Att_3d_ HIV-discordant Partners Consent Form- English.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 590

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 Agency Discretion
Annual Number of Responses for this IC	590	590
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A.docx	05/06/2014
Supporting Statement B	Supporting Statement B.docx	05/06/2014
ABT IRB Approval	Att_4a_ABT IRB Approval Letter.pdf	05/06/2014
Emory IRB Approval	Att_4b_Emory University IRB Approval Letter.docx	05/06/2014
Provider recruitment script	Att_5a_Provider Recruitment Script.docx	05/06/2014
PLWH recruitment ads - English	Att_5b_PLWH Recruitment Advertisement English.docx	05/06/2014
PLWH recruitment ads - Spanish	Att_5c_PLWH Recruitment Advertisement Spanish.docx	05/06/2014
PLWH Recruitment flyers - English	Att_5d_PLWH RecruitFlyersEnglish.pdf	05/06/2014
PLWH recruitment flyers - Spanish	Att_5e_PLWH RecruitFlyersSpanish.pdf	05/06/2014
Spanish translation certification	Att_6a_Spanish Translation Certification.pdf	05/06/2014
ABT data security plan	Att_7a_ABT Data Security Plan.docx	05/06/2014
RSS data security plan	Att_7b_RSS Data Security Plan.docx	05/06/2014

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