Examination of Jail and Prison Policies Related to STD Prevention

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
Examination of Jail and Prison Policies Related to STD Prevention Form and Instruction
Vulnerable Populations Project Key Informant Interview G Att 3-Key Informant Interview Instrument.docx Form and Instruction
SSA.docx Supporting Statement A IC Document
SSB.docx Supporting Statement B IC Document
Att 2-Project Summary.doc Project Summary IC Document
Att 4-PHMC IRB Exemption Letter_Jails.pdf IRB Exemption Letter IC Document
Att 5-NotificationEmail.docx Email Notification IC Document
Att 6-Follow up phone script.docx Follow-Up Phone Script IC Document

Information Collection (IC) Details

IC Title:	Examination of Jail and Prison Policies Related to STD Prevention	Agency IC Tracking Number:	16PT

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Vulnerable Populations Project Key Informant Interview Guide	Att 3-Key Informant Interview Instrument.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SSA.docx	02/19/2016
Supporting Statement B	SSB.docx	02/19/2016
Project Summary	Att 2-Project Summary.doc	02/19/2016
IRB Exemption Letter	Att 4-PHMC IRB Exemption Letter_Jails.pdf	02/19/2016
Email Notification	Att 5-NotificationEmail.docx	02/19/2016
Follow-Up Phone Script	Att 6-Follow up phone script.docx	02/19/2016

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