Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey Form and Instruction
Act Against AIDS In-Person Survey Att1-AAA-Survey-Instrument.docx Form and Instruction
Act Against AIDS Online Survey (Screenshots) Att3-Screenshots-AAA-Usability.docx Form and Instruction
In-Person Fast_Track_GenIC_Request.docx GenIC Request In-Person IC Document
Online Fast_Track_Template.docx GenIC Request Online IC Document
Att2-AAA-Facilitator Packet_Consent&Script.docx Facilitator Packet In-Person IC Document
Att4-AAA-In-person-RecruitmentEmail.docx Recruitment Email IC Document
Att5-Sample-Participitation-Invitations.docx Sample Participation Invite In-Person/Online IC Document

Information Collection (IC) Details

IC Title:	Baseline Usability Testing for DHAP's Act Against AIDS Website- Online Survey	Agency IC Tracking Number:	0920-1027-16CF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Act Against AIDS In-Person Survey	Att1-AAA-Survey-Instrument.docx	NA	No		Paper Only
Form and Instruction	NA	Act Against AIDS Online Survey (Screenshots)	Att3-Screenshots-AAA-Usability.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 130	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request In-Person	In-Person Fast_Track_GenIC_Request.docx	11/12/2015
GenIC Request Online	Online Fast_Track_Template.docx	11/12/2015
Facilitator Packet In-Person	Att2-AAA-Facilitator Packet_Consent&Script.docx	11/12/2015
Recruitment Email	Att4-AAA-In-person-RecruitmentEmail.docx	11/12/2015
Sample Participation Invite In-Person/Online	Att5-Sample-Participitation-Invitations.docx	11/12/2015

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