Information Collection

Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study

IC 221497 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⚠️ Notice: This information collection may be referencing outdated material.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
Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study	Form and Instruction
Eligibility Screening Form - Online Att 2e_Online Screening Form.docx	Form and Instruction
Contact Information Form - Online Att 2f_Online Contact Information Form.docx	Form and Instruction
Eligibility Screening Form - Reverification Att 2a_Screening Form.docx	Form and Instruction
Focus Group Guide Att 2c_Focus Group Guide.docx	Form and Instruction
In-Depth Interview Guide Att 2d_In-depth Interview Guide.docx	Form and Instruction
Att 1_Recruitment Materials.docx MSM Study Recruitment Materials	IC Document
Att 4_Messages for Testing.docx Messages for Testing	IC Document
Att 5a_Emory IRB Letter of Approval.pdf Emory University IRB Approval	IC Document
Att 5b_Public Health Solutions IAA.pdf Public Health Solutions IRB Authorization Agreement	IC Document
Att 5c_University of Michigan IAA.pdf University of Michigan IRB Authorization Agreement	IC Document
Att 3a_Focus Group Consent.docx Focus Group Consent	IC Document
Att 3b_In-depth Interview Consent.docx In-Depth Interview Consent	IC Document
SSA.docx Supporting Statement A	IC Document
SSB.docx Supporting Statement B	IC Document

IC Title:

Development of a Mobile Messaging Intervention for Men who have Sex with Men: Formative Study

Agency IC Tracking Number:

16AIC

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	Eligibility Screening Form - Online	Att 2e_Online Screening Form.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Contact Information Form - Online	Att 2f_Online Contact Information Form.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Eligibility Screening Form - Reverification	Att 2a_Screening Form.docx	NA	No		Fillable Fileable
Form and Instruction	NA	Focus Group Guide	Att 2c_Focus Group Guide.docx	NA	No		Paper Only
Form and Instruction	NA	In-Depth Interview Guide	Att 2d_In-depth 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: 848

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	848	848
Annual IC Time Burden (Hours)	243	243
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MSM Study Recruitment Materials	Att 1_Recruitment Materials.docx	05/12/2016
Messages for Testing	Att 4_Messages for Testing.docx	05/12/2016
Emory University IRB Approval	Att 5a_Emory IRB Letter of Approval.pdf	05/12/2016
Public Health Solutions IRB Authorization Agreement	Att 5b_Public Health Solutions IAA.pdf	05/12/2016
University of Michigan IRB Authorization Agreement	Att 5c_University of Michigan IAA.pdf	05/12/2016
Focus Group Consent	Att 3a_Focus Group Consent.docx	05/12/2016
In-Depth Interview Consent	Att 3b_In-depth Interview Consent.docx	05/12/2016
Supporting Statement A	SSA.docx	05/13/2016
Supporting Statement B	SSB.docx	05/13/2016

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