Formative Research and Tool Development

ICR 201511-0920-001

OMB: 0920-0840

Federal Form Document

Forms and Documents
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Form and Instruction
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Supplementary Document
2015-11-02
Supporting Statement B
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2015-11-02
Supplementary Document
2013-01-31
Supporting Statement A
2015-11-03
IC Document Collections
IC ID
Document
Title
Status
232609 New
232126 New
231185 New
231025 New
228661 New
228556 New
226015 New
225744 New
223954 New
221497 New
220155 New
219919 New
ICR Details
0920-0840 201511-0920-001
Historical Active 201301-0920-010
HHS/CDC 18699
Formative Research and Tool Development
Extension without change of a currently approved collection   No
Regular
Approved without change 01/26/2016
Retrieve Notice of Action (NOA) 11/16/2015
Previous terms continue: OMB approves this umbrella generic, and has informed CDC that each individual study should be submitted into ROCIS an a genIC that includes the actual study instruments and a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans.
  Inventory as of this Action Requested Previously Approved
01/31/2019 36 Months From Approved 02/29/2016
121,800 0 121,800
46,516 0 46,516
0 0 0
The data collection and evidence are developed using a multitude of information sources and short term qualitative interviewing and cognitive research techniques have been proven invaluable in the development of scientifically valid and population-appropriate methods, interventions, and instruments. The activities conducted under this information collection will be used to inform many aspects of surveillance, communications, health promotion, and research project development for the 4 priority diseases (HIV, STDs, TB, and viral hepatitis) as well as school and adolescent health.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  80 FR 36540 06/25/2015
80 FR 66007 10/28/2015
Yes
12
IC Title Form No. Form Name
Examination of Jail and Prison Policies Related to STD Prevention NA Vulnerable Populations Project Key Informant Interview Guide
Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study NA, NA, NA, NA, NA Eligibility Screening Form - Online ,   Contact Information Form - Online ,   Eligibility Screening Form - Reverification ,   Focus Group Guide ,   In-Depth Interview Guide
Formative Research on Resilience and Transgender Youth N/A, N/A Qualitative Interview Guide ,   Eligibility Screener
Project Engage 2.0: Engaging Gay "Community" Activism for Syphilis Prevention
Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM none, none, none, none Survey screener ,   Survey - word ,   Survey AMSM - screenshots ,   Survey Trans - screenshots
Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP 0920-0840 Interview Guide
Assessment of STD Service Needs and Provisions none, none Patient Questionnaire ,   Administrative Questionnaire
Student and Teacher Perspectives on Sexual Health Education in Fort Worth Independent School District 0920-16ML, 0920-16ML, 0920-16ML, 0920-16ML Att 2-Teacher Interview Guide ,   Att 4-Middle School Student Focus Group Guide ,   Att 5-High School Student Focus Group Guide ,   Att 8-Teacher Interview Consent Form
Developing Tools to Engage Adolescent Men Who Have Sex with Men (AMSM) n/a, n/a, n/a, n/a, n/a, n/a Screener for In-person AMSM and Transgender Focus Groups ,   Screener for Online AMSM and Transgender Focus Groups ,   AMSM Focus Group Guide ,   Screenshots of AMSM Focus Group Guide ,   Transgender Youth Focus Group Guide ,   Screenshots of Transgender Youth Focus Group Guide
2018 Congenital Syphilis Study 0920-0840, 0920-0840, 0920-0840, 0920-0840 Eligibility Screener - Prenatal Care Providers ,   Interview Guide - Prenatal Care Providers ,   Eligibility Sreener - Pregnant Women ,   Interview Guide - Pregnant Women
Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District N/A Middle School Focus Group Guide
Project Engage: Engaging Gay "Community" Activism for Syphilis Prevention NA, NA Eligibility Screener ,   Telephone Interview Guide
  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 121,800 121,800 0 0 0 0
Annual Time Burden (Hours) 46,516 46,516 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$574,000
No
No
No
No
No
Uncollected
Thelma Sims 4046394771
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/16/2015
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