Information Collection

Examination of Jail and Prison Policies Related to STD Prevention

IC 220155 under ICR 201511-0920-001 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.