Information Collection Request

HIV Study in Blood Donors from Five Chinese Regions (NHLBI)

ICR 201411-0925-001 · OMB 0925-0596 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2 HIV Questionaire Informed Consent Form New Available
Form 1 HIV Risk Factor Questionnaire English Form and Instruction New Available
Form 2 HIV Questionaire Informed Consent Form New Available
Form 1 HIV Risk Factor Questionnaire English Form and Instruction New Available
Form 2 HIV Questionaire Informed Consent Form New Available
Form 1 HIV Risk Factor Questionnaire English Form and Instruction New Available
Form 2 HIV Questionaire Informed Consent Form New Available
Form 1 HIV Risk Factor Questionnaire English Form and Instruction New Available
Form 1.2 HBV HCV Form and Instruction Removed Available
Form 1.1 HIV Form and Instruction Removed Available
Attachment_6.1_ China HIV Study Protocol_050914.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_5.4_HIV_China_Steering_Committee_4_2014_V_2.0.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_5.3_HIV_IAC_Advisory_Committee_1_2014_V_1.0.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_5.2_Survey_Questionaire_Justification_4_2014_6.0.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_5.1_HIV__OSMB_Members_1_2014_V_1.0.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_4_Follow-up call_11_2014_V_4.0.docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_3_Introduction over phone_8_2013_V_4 0 (2).docx Supplementary Document Uploaded 2014-11-05 Available
Attachment_1.2_HIV_Risk_Factor_Q_Web_Screen_Shots_11_2014_v_4.0.docx Supplementary Document Uploaded 2014-11-05 Available
Supporting_Statment_B_HIV_China_7_2014_V_9.0.docx Supporting Statement B Uploaded 2014-11-05 Available
Supporting Statement A_HIV_China_11_2014_V_20.0.docx Supporting Statement A Uploaded 2014-11-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213750 HIV Risk Factor Questionnaire Blood donors Control Peripheral Sites Form NewHIV Questionaire Informed Consent
213750 HIV Risk Factor Questionnaire Blood donors Control Peripheral Sites Form and Instruction NewHIV Risk Factor Questionnaire English
213749 HIV Risk Factor Questionnaire Blood donors Control Primary Sites Form NewHIV Questionaire Informed Consent
213749 HIV Risk Factor Questionnaire Blood donors Control Primary Sites Form and Instruction NewHIV Risk Factor Questionnaire English
213748 HIV Risk Factor Questionnaire Blood donors Case Peripheral Sites Sites Form NewHIV Questionaire Informed Consent
213748 HIV Risk Factor Questionnaire Blood donors Case Peripheral Sites Sites Form and Instruction NewHIV Risk Factor Questionnaire English
213747 HIV Risk Factor Questionnaire Blood donors Case Primary Sites Form NewHIV Questionaire Informed Consent
213747 HIV Risk Factor Questionnaire Blood donors Case Primary Sites Form and Instruction NewHIV Risk Factor Questionnaire English
187041 HBV and HCV Risk Factor Form and Instruction RemovedHBV HCV
187040 HIV Risk Factor Form and Instruction RemovedHIV

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2017 36 Months From Approved 01/31/2012
1,350 0 3,920
450 0 1,294
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
HBV and HCV Risk Factor 1.2
HIV Risk Factor 1.1
HIV Risk Factor Questionnaire Blood donors Case Peripheral Sites Sites 2, 1 ,  
HIV Risk Factor Questionnaire Blood donors Case Primary Sites 1, 2 ,  
HIV Risk Factor Questionnaire Blood donors Control Peripheral Sites 1, 2 ,  
HIV Risk Factor Questionnaire Blood donors Control Primary Sites 1, 2 ,  

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 1,350 3,920 0 -2,570 0 0
Annual Time Burden (Hours) 450 1,294 0 -844 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No