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⚠️ Notice: This information collection may be referencing outdated material.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

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:

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

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 %

	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

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.