Information Collection

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

IC 218898 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.