Information Collection

The Data to Care (D2C) Public Health Strategy: Successes, Challenges, and Lessons Learned in Identifying, Linking, and Reengaging Persons Diagnosed with HIV to Medical Care

IC 230695 under ICR 201505-0920-007 · OMB 0920-1091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1091 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1091 The Data to Care (D2C) Public Health Strategy: Successes, Challenges, and Lessons Learned in Identifying, Linking, and Reengaging Persons Diagnosed with HIV to Medical Care	Form and Instruction
0920-1091 D2C Client Screener Att 3a D2C Client Screener.docx	Form and Instruction
0920-1091 D2C Client Interview Guide Att 3b D2C Client Interview Guide - Revised 12MAR2018 - Clean.DOCX	Form and Instruction
0920-1091 D2C Program Staff Interview Guide Att 3c D2C Program Staff Interview Guide.DOCX	Form and Instruction
Att 1 D2C Recruitment Flyers.pdf D2C Recruitment Flyers	IC Document
Att 2 D2C Informed Consent Forms.docx Informed Consent Forms	IC Document
Att 4a CDC IRB Approval 7072 New Approval Protocol_.pdf CDC IRB Approval	IC Document
Att 4b Emory U IRB determination.pdf Emory IRB Approval	IC Document
Att 5 D2C Data Use Plan.doc D2C Data Use Plan	IC Document
Att 6 Privacy Impact Assessment.pdf Privacy Impact Assessment	IC Document
SSA_Revised 13MAR2018.docx Supporting Statement A	IC Document
SSB.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

The Data to Care (D2C) Public Health Strategy: Successes, Challenges, and Lessons Learned in Identifying, Linking, and Reengaging Persons Diagnosed with HIV to Medical Care

Agency IC Tracking Number:

0920-1091-18QE

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?	Electronic Capability
Form and Instruction	0920-1091	D2C Client Screener	Att 3a D2C Client Screener.docx	NA	No	Paper Only
Form and Instruction	0920-1091	D2C Client Interview Guide	Att 3b D2C Client Interview Guide - Revised 12MAR2018 - Clean.DOCX	NA	No	Paper Only
Form and Instruction	0920-1091	D2C Program Staff Interview Guide	Att 3c D2C Program Staff Interview Guide.DOCX	NA	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210

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	210	210
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
D2C Recruitment Flyers	Att 1 D2C Recruitment Flyers.pdf	03/14/2018
Informed Consent Forms	Att 2 D2C Informed Consent Forms.docx	03/14/2018
CDC IRB Approval	Att 4a CDC IRB Approval 7072 New Approval Protocol_.pdf	03/14/2018
Emory IRB Approval	Att 4b Emory U IRB determination.pdf	03/14/2018
D2C Data Use Plan	Att 5 D2C Data Use Plan.doc	03/14/2018
Privacy Impact Assessment	Att 6 Privacy Impact Assessment.pdf	03/14/2018
Supporting Statement A	SSA_Revised 13MAR2018.docx	03/14/2018
Supporting Statement B	SSB.docx	03/14/2018

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