Information Collection

Pilot Test Study for the HIV Risk Reduction Educational Tool (HRRET)

IC 214195 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 10_HRRET Screenshots 11DEC2014.pdf	Other-HRRET Website Content
Pilot Study HRRET Screener Survey Att2_Screener.pdf	Form and Instruction
Pilot Test HRRET PRETEST Web-based Survey Att3a_PreTest.pdf	Form and Instruction
Pilot Test HRRET POSTTEST Web-based Survey Att3b_PostTest.pdf	Form and Instruction
Att 1_Sect 301 PHSA.pdf Authorizing Legislation	IC Document
Att 2_Screener (2).docx HRRET Screener Survey - WORD	IC Document
Att 2a_Exploration Period.docx HRRET Exploration Period	IC Document
Att 3a_Pretest Survey.docx HRRET PRETEST Survey - WORD	IC Document
Att 3b_Posttest Survey.docx HRRET POSTTEST Survey - WORD	IC Document
Att 4_Email Reminder.docx HRRET Sample Email reminder	IC Document
Att 5_Study Consent.doc HRRET Study Consent	IC Document
Att 6_Recruitment Ads.doc HRRET Recruitment Ads	IC Document
Att 7_Sample Google Ad.docx HRRET Sample Google Ad	IC Document
Att 8_Message Topics.doc HRRET Message Topics	IC Document
Att 9_Sample Amazon Delivery Template.doc HRRET Sample Amazon Delivery Template	IC Document
Supporting Statement A 11DEC2014.doc Supporting Statement A	IC Document
Supporting Statement B 11DEC2014.docx Supporting Statement B	IC Document

IC Title:

Pilot Test Study for the HIV Risk Reduction Educational Tool (HRRET)

Agency IC Tracking Number:

15FT

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HRRET Website Content			Att 10_HRRET Screenshots 11DEC2014.pdf	None	Yes	No	Printable Only
Form and Instruction	None	Pilot Study HRRET Screener Survey	Att2_Screener.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Pilot Test HRRET PRETEST Web-based Survey	Att3a_PreTest.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Pilot Test HRRET POSTTEST Web-based Survey	Att3b_PostTest.pdf	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	1,750	1,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	Att 1_Sect 301 PHSA.pdf	12/09/2014
HRRET Screener Survey - WORD	Att 2_Screener (2).docx	12/09/2014
HRRET Exploration Period	Att 2a_Exploration Period.docx	12/09/2014
HRRET PRETEST Survey - WORD	Att 3a_Pretest Survey.docx	12/09/2014
HRRET POSTTEST Survey - WORD	Att 3b_Posttest Survey.docx	12/09/2014
HRRET Sample Email reminder	Att 4_Email Reminder.docx	12/09/2014
HRRET Study Consent	Att 5_Study Consent.doc	12/09/2014
HRRET Recruitment Ads	Att 6_Recruitment Ads.doc	12/09/2014
HRRET Sample Google Ad	Att 7_Sample Google Ad.docx	12/09/2014
HRRET Message Topics	Att 8_Message Topics.doc	12/09/2014
HRRET Sample Amazon Delivery Template	Att 9_Sample Amazon Delivery Template.doc	12/09/2014
Supporting Statement A	Supporting Statement A 11DEC2014.doc	12/12/2014
Supporting Statement B	Supporting Statement B 11DEC2014.docx	12/12/2014

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