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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.