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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 211515 under ICR 201301-0920-010 · OMB 0920-0840.

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted 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

Health Public Health Monitoring

 

590 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 590 0 590 0 0 0
Annual IC Time Burden (Hours) 167 0 167 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.