Information Collection

Local Effectiveness Assessment Project (LEAP): A Case Study of a Local Jurisdiction Providing HIV Services to MSM

IC 217215 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⚠️ Notice: This information collection may be referencing outdated material.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
Local Effectiveness Assessment Project (LEAP): A Case Study of a Local Jurisdiction Providing HIV Services to MSM	Form and Instruction
Interview Guide - Public Policy Stakeholders Att 2a_Interview Guide_Public Policy (00000002)_22June2015.docx	Form and Instruction
Interview Guide - Community Leaders Att 2b_Interview Guide_Community Leaders (00000002)_22June2015.docx	Form and Instruction
Interview Guide - Individual/Network Att 2c_Interview Guide_Individuals (00000002)_22June2015.docx	Form and Instruction
Key Participant Information Sheet and Consent Form Att 3_Key Participant Info Sheet and Consent.docx	Form and Instruction
Supporting Statement A_22June2015.docx Supporting Statement A	IC Document
Supporting Statement B_22June2015.docx Supporting Statement B	IC Document
Att 5a_Key Participant Recruitment Script.docx Participant Recruitment Script	IC Document
Att 5b_Brief Study Overview.docx Study Overview	IC Document
Att 6_LEAP Data Security Plan.docx Data Security Plan	IC Document

IC Title:

Local Effectiveness Assessment Project (LEAP): A Case Study of a Local Jurisdiction Providing HIV Services to MSM

Agency IC Tracking Number:

15AQL

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?	Electronic Capability
Form and Instruction	None	Interview Guide - Public Policy Stakeholders	Att 2a_Interview Guide_Public Policy (00000002)_22June2015.docx	None	No	Fillable Fileable
Form and Instruction	None	Interview Guide - Community Leaders	Att 2b_Interview Guide_Community Leaders (00000002)_22June2015.docx	None	No	Fillable Fileable
Form and Instruction	None	Interview Guide - Individual/Network	Att 2c_Interview Guide_Individuals (00000002)_22June2015.docx	None	No	Fillable Fileable
Form and Instruction	None	Key Participant Information Sheet and Consent Form	Att 3_Key Participant Info Sheet and Consent.docx	None	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	60	60
Annual IC Time Burden (Hours)	33	33
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_22June2015.docx	06/25/2015
Supporting Statement B	Supporting Statement B_22June2015.docx	06/25/2015
Participant Recruitment Script	Att 5a_Key Participant Recruitment Script.docx	06/25/2015
Study Overview	Att 5b_Brief Study Overview.docx	06/25/2015
Data Security Plan	Att 6_LEAP Data Security Plan.docx	06/25/2015

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