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

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.