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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.