Information Collection

Providing Insight into how the Safer Sex Intervention Works: Understanding Experiences of Youth and Health Educators

IC 223402 under ICR 201403-0990-004 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A_FocusGroup_Guide_Youth_Revised 9.1.16.docx	Other-focus group
B_FocusGroup_Guide_HealthEducators Revised 9.1.16.docx	Other-GUIDE
SSA_Hennepin Focus Groups OIRA update 9-2-16 CLEAN.docx SS-A	IC Document
SSB_Hennepin Focus Groups Revised 8.29.16 CLEAN.docx SS-B	IC Document
D - Youth Recruitment Email Scripts.docx EMAIL SCRIPT	IC Document
C-Consent Forms for Participation OIRA updated 9-2-16 CLEAN.docx CONSENT	IC Document
E - Recruitment email for Health Educators.docx RECRUITMENT	IC Document

IC Title:

Providing Insight into how the Safer Sex Intervention Works: Understanding Experiences of Youth and Health Educators

Agency IC Tracking Number:

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-focus group			A_FocusGroup_Guide_Youth_Revised 9.1.16.docx		No		Paper Only
Other-GUIDE			B_FocusGroup_Guide_HealthEducators Revised 9.1.16.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

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	48	48
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS-A	SSA_Hennepin Focus Groups OIRA update 9-2-16 CLEAN.docx	09/07/2016
SS-B	SSB_Hennepin Focus Groups Revised 8.29.16 CLEAN.docx	09/07/2016
EMAIL SCRIPT	D - Youth Recruitment Email Scripts.docx	09/07/2016
CONSENT	C-Consent Forms for Participation OIRA updated 9-2-16 CLEAN.docx	09/07/2016
RECRUITMENT	E - Recruitment email for Health Educators.docx	09/07/2016

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