National HIV Behavioral Surveillance System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Behavioral Assessment - HET - Spanish	Form and Instruction	Modified	Available
Behavioral Assessment - HET	Form and Instruction	Modified	Available
Behavioral Assessment - IDU - Spanish	Form and Instruction	Modified	Available
Behavioral Assessment - IDU	Form and Instruction	Modified	Available
Recruiter Debriefing	Form and Instruction	Modified	Available
Recruiter Debriefing - Spanish	Form and Instruction	Modified	Available
Behavioral Assessment - MSM - Spanish	Form and Instruction	Modified	Available
Behavioral Assessment - MSM	Form and Instruction	Modified	Repair queued
Eligibility Screener	Form and Instruction	Modified	Available
Eligibility Screener - Spanish	Form and Instruction	Modified	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2014-02-24	Available
Att 15_References.docx	Supplementary Document	Uploaded 2014-02-24	Available
Att 14_Response rate calculations.docx	Supplementary Document	Uploaded 2014-02-24	Available
Att 12_Model recruitment coupon.docx	Supplementary Document	Uploaded 2014-02-24	Available
Att 11_Sample analysis tables.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 10_CDC IRB determination.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 9_Model Consent Form.docx	Supplementary Document	Uploaded 2014-02-24	Available
Att 8_Consultants.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 7_NHBS cycle overview.pdf	Supplementary Document	Uploaded 2014-02-24	Repair queued
Att 6_Agreement to abide by restrictions.docx	Supplementary Document	Uploaded 2014-02-24	Available
Att 5_Assurance of Confidentiality.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 4_NHBS Publications.doc	Supplementary Document	Uploaded 2014-02-24	Available
Att 2_60 Day FRN.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 1b_Auth to Operate for DCC.pdf	Supplementary Document	Uploaded 2014-02-24	Repair queued
Att 1b_Auth to Operate for DCC.pdf	Supplementary Document	Uploaded 2014-02-24	Available
Att 13_Recruiter training script.docx	Supplementary Document	Uploaded 2014-02-24	Repair queued
Supporting Statement A.docx	Supporting Statement A	Uploaded 2014-02-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Behavioral Assessment - HET - Spanish
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Behavioral Assessment - HET
196957	NHBS Behavioral Assessment (IDU)	Form and Instruction	Modified	Behavioral Assessment - IDU - Spanish
196957	NHBS Behavioral Assessment (IDU)	Form and Instruction	Modified	Behavioral Assessment - IDU
196956	NHBS Recruiter Debriefing	Form and Instruction	Modified	Recruiter Debriefing
196956	NHBS Recruiter Debriefing	Form and Instruction	Modified	Recruiter Debriefing - Spanish
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Behavioral Assessment - MSM - Spanish
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Behavioral Assessment - MSM
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Eligibility Screener
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Eligibility Screener - Spanish

ICR Details

OMB Control No: 0920-0770	ICR Reference No: 201402-0920-017
Status: Historical Active	Previous ICR Reference No: 201112-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 21474
Title: National HIV Behavioral Surveillance System
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/31/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	05/31/2014
Responses	31,668	0	31,668
Time Burden (Hours)	9,932	0	9,932
Cost Burden (Dollars)	0	0	0

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Abstract: The NHBS was designed to address the need for a national behavioral surveillance system for persons at risk for HIV infection. The primary objective is to conduct behavioral surveillance among persons at high-rsk for HIV in the US to assess prevalence of and trends in 1)risk behaviors, 2) HIV testing behaviors, 3)HIV seroprevalence and incidence, and 4) exposure to, use of, and impact of HIV prevention services. CDC works with state and local health depts. to collect data through anonymous interviews with men who have sex with men, injecting drug users, and heterosexuals at increased risk. NHBS addresses the goal of strengthening the capacity to monitor the epidemic to better direct and evaluate prevention efforts.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 306 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 70561	11/26/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 10525	02/25/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
NHBS Behavioral Assessment (IDU)	none, none	Behavioral Assessment - IDU ,   Behavioral Assessment - IDU - Spanish
NHBS Behavioral Assessment (MSM)	none, none	Behavioral Assessment - MSM ,   Behavioral Assessment - MSM - Spanish
NHBS Behavioral Assessment Survey (HET)	none, none	Behavioral Assessment - HET ,   Behavioral Assessment - HET - Spanish
NHBS Recruiter Debriefing	none, none	Recruiter Debriefing - Spanish ,   Recruiter Debriefing
NHBS Screening (All Respondent Groups)	none, none	Eligibility Screener - Spanish ,   Eligibility Screener

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	31,668	31,668	0	0	0	0
Annual Time Burden (Hours)	9,932	9,932	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $11,244,752

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/28/2014

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