Information Collection

Development of Messages for the Act Against AIDS National Testing Campaign

IC 217066 under ICR 201502-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Development of Messages for the Act Against AIDS National Testing Campaign	Form
Development of Messages Survey Att 2_Web-Based Survey.docx	Form
Development of Messages Survey - screenshots Att 2a_New National Screen Shots.pdf	Form
Screener Att 3_Web-Based Screener.docx	Form
Supporting Statement A-Clean.docx Supporting Statement A	IC Document
Supporting Statement B.docx Supporting Statement B	IC Document
Att 4_Consent.docx Consent	IC Document
Att 5_Email Reminder.docx Email Notification	IC Document
Concepts.pdf Messages	IC Document
Table shells_Web Survey_OMB_2015-2-24.docx Table Shells	IC Document

IC Title:

Development of Messages for the Act Against AIDS National Testing Campaign

Agency IC Tracking Number:

15MG

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Development of Messages Survey	Att 2_Web-Based Survey.docx	Yes	Yes	Fillable Fileable
Form	none	Development of Messages Survey - screenshots	Att 2a_New National Screen Shots.pdf	Yes	Yes	Fillable Fileable
Form	none	Screener	Att 3_Web-Based Screener.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,744

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	3,744	3,744
Annual IC Time Burden (Hours)	871	871
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A-Clean.docx	06/17/2015
Supporting Statement B	Supporting Statement B.docx	06/17/2015
Consent	Att 4_Consent.docx	06/17/2015
Email Notification	Att 5_Email Reminder.docx	06/17/2015
Messages	Concepts.pdf	06/17/2015
Table Shells	Table shells_Web Survey_OMB_2015-2-24.docx	06/17/2015

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