Information Collection Request

Formative Research and Tool Development

ICR 201511-0920-001 · OMB 0920-0840 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Assessment of STD Service Needs and Provisions Form New Available
Form 0920-0840 Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP Form New Repair queued
Form 0920-0840 2018 Congenital Syphilis Study Form and Instruction New Available
Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM Form New Repair queued
Developing Tools to Engage Adolescent Men Who Have Sex with Men (AMSM) Form and Instruction New Available
Project Engage: Engaging Gay "Community" Activism for Syphilis Prevention Form and Instruction New Available
Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District Form and Instruction New Available
Formative Research on Resilience and Transgender Youth Form and Instruction New Available
Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study Form and Instruction New Available
Examination of Jail and Prison Policies Related to STD Prevention Form and Instruction New Available
Form 0920-16ML Student and Teacher Perspectives on Sexual Health Education in Fort Worth Independent School District Form and Instruction New Available
Att 10 List of Approved GenICs.docx Supplementary Document Uploaded 2015-11-02 Repair queued
SSB Generic_0840_102315.docx Supporting Statement B Uploaded 2015-11-02 Available
Att 9 Example Consent Form.docx Supplementary Document Uploaded 2015-11-02 Available
Att 2B 60 DayFRN Comments.pdf Supplementary Document Uploaded 2015-11-02 Available
Att 8 DHAP ConfidAssurance.doc Supplementary Document Uploaded 2015-11-02 Available
Att 7 Example Group Interview Guide.doc Supplementary Document Uploaded 2015-11-02 Available
Att 6 Sample Screening Tool.doc Supplementary Document Uploaded 2015-11-02 Available
Att 5 Example Survey.doc Supplementary Document Uploaded 2015-11-02 Available
Att 4 Example Individual Interview Guide.doc Supplementary Document Uploaded 2015-11-02 Available
Att 3 Example Questions.doc Supplementary Document Uploaded 2015-11-02 Available
Att 2 60 Day FRN.pdf Supplementary Document Uploaded 2015-11-02 Available
Att 1 AuthLegislation.doc Supplementary Document Uploaded 2013-01-31 Available
SSA Generic_0840_110315.doc Supporting Statement A Uploaded 2015-11-03 Available

ICR Details

Reginfo record details
table that charts list comparision
  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





Reginfo record details
12
table that charts list of burden
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

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 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


Reginfo record details
  No