Information Collection

Evaluating Social Marketing Campaigns Targeting Gay/Bisexual Men

IC 213907 under ICR 201403-0920-004 · OMB 0920-0920.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0920 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
att1_surveyscreenshots.pdf	Other-PDF
att2_screenerscreenshots.pdf	Other-PDF
Att 3_Consent Form.docx Att 3 Consent Form	IC Document
Att 4_Email Reminder.docx Att 4_Email Reminder	IC Document
Supporting Statement A.docx Supporting Statement A	IC Document
Supporting Statement B_9-23-14 Clean.docx Supporting Statement B	IC Document

IC Title:

Evaluating Social Marketing Campaigns Targeting Gay/Bisexual Men

Agency IC Tracking Number:

14AYF

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-PDF			att1_surveyscreenshots.pdf		Yes	Yes	Fillable Printable
Other-PDF			att2_screenerscreenshots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,000

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	18,000	18,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3 Consent Form	Att 3_Consent Form.docx	11/14/2014
Att 4_Email Reminder	Att 4_Email Reminder.docx	11/14/2014
Supporting Statement A	Supporting Statement A.docx	11/14/2014
Supporting Statement B	Supporting Statement B_9-23-14 Clean.docx	11/14/2014

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