Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM

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⚠️ Notice: This information collection may be referencing outdated material.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
Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM Form
Survey screener Att 1a Screener AMSM Survey_.docx Form
Survey - word Att 1c AMSM_Trans Survey.docx Form
Survey AMSM - screenshots Att 1d ScreenShots - AMSM.docx Form
Survey Trans - screenshots Att 1e ScreenShots - Trans.docx Form
Att 1b AMSM Screener Diagram.pdf Survey Eligibility Flowchart IC Document
Att 2 Consent & Assent Landing.docx Flyer IC Document
Att 3a NORC IRB Approval Letter.pdf IRB approval IC Document
Att 3b NORC IRB Approval Amendment 1.pdf IRB Amendment IC Document
Att 3c NORC IRB Approval Amendment 2.pdf IRB amendment IC Document
Att 3d NORC IRB Renewal Letter.pdf IRB Renewal IC Document
Att 3e NORC IRB Approval Amendment 3.pdf IRB amendment IC Document
Att 3g Sensitive Questions.docx Explanation for Sensitive Questions IC Document
Att 4a Web Recruitment Ads.docx Web advertisement IC Document
Att 4b Snapchat Recruitment Ads.docx Snapchat advertisement IC Document
Att 4c Example Snapchat Video.mp4 Snapchat video ads IC Document
Att 5 Data Security Plan.docx System Security Plan IC Document
SSB.10.19.docx Supporting statement B IC Document
SSA.10.19.docx Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Formative Tools for Addressing HIV Prevention Preferences among Adolescent MSM	Agency IC Tracking Number:	0920-0840-18AX

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Survey screener	Att 1a Screener AMSM Survey_.docx	Yes	Yes	Fillable Fileable
Form	none	Survey - word	Att 1c AMSM_Trans Survey.docx	Yes	Yes	Fillable Fileable
Form	none	Survey AMSM - screenshots	Att 1d ScreenShots - AMSM.docx	Yes	Yes	Fillable Fileable
Form	none	Survey Trans - screenshots	Att 1e ScreenShots - Trans.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,875	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,875	7,875
Annual IC Time Burden (Hours)	1,677	1,677
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Eligibility Flowchart	Att 1b AMSM Screener Diagram.pdf	10/19/2017
Flyer	Att 2 Consent & Assent Landing.docx	10/19/2017
IRB approval	Att 3a NORC IRB Approval Letter.pdf	10/19/2017
IRB Amendment	Att 3b NORC IRB Approval Amendment 1.pdf	10/19/2017
IRB amendment	Att 3c NORC IRB Approval Amendment 2.pdf	10/19/2017
IRB Renewal	Att 3d NORC IRB Renewal Letter.pdf	10/19/2017
IRB amendment	Att 3e NORC IRB Approval Amendment 3.pdf	10/19/2017
Explanation for Sensitive Questions	Att 3g Sensitive Questions.docx	10/19/2017
Web advertisement	Att 4a Web Recruitment Ads.docx	10/19/2017
Snapchat advertisement	Att 4b Snapchat Recruitment Ads.docx	10/19/2017
Snapchat video ads	Att 4c Example Snapchat Video.mp4	10/19/2017
System Security Plan	Att 5 Data Security Plan.docx	10/19/2017
Supporting statement B	SSB.10.19.docx	10/19/2017
Supporting Statement A	SSA.10.19.docx	10/19/2017

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