Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0840 Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP Form
0920-0840 Interview Guide Att 1_Interview Guide.docx Form
Supporting Statement A.docx Supporting Statement A IC Document
Supporting Statement B.docx Supporting Statement B IC Document
Att 2_Recruitment Script.docx Att 2 Recruitment Script IC Document
Att 3_Verbal Informed Consent.docx Att 3 Verbal Informed Consent IC Document
Att 4_Assurance of Confidentiality.pdf Att 4 Assurance of Confidentiality IC Document
Att 5_Project Determination.pdf Att 5 Project Determination IC Document
Att 6_AgreementToAbide by Restrictions.docx Att 6_Agreement to Abide by Restrictions IC Document
Att 7_Privacy Impact Assessment.pdf Att 7 Privacy Impact Assessment IC Document

Information Collection (IC) Details

IC Title:	Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP	Agency IC Tracking Number:	0920-0840 (18ACM)

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	0920-0840	Interview Guide	Att 1_Interview Guide.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A.docx	04/24/2018
Supporting Statement B	Supporting Statement B.docx	04/24/2018
Att 2 Recruitment Script	Att 2_Recruitment Script.docx	04/24/2018
Att 3 Verbal Informed Consent	Att 3_Verbal Informed Consent.docx	04/24/2018
Att 4 Assurance of Confidentiality	Att 4_Assurance of Confidentiality.pdf	04/24/2018
Att 5 Project Determination	Att 5_Project Determination.pdf	04/24/2018
Att 6_Agreement to Abide by Restrictions	Att 6_AgreementToAbide by Restrictions.docx	04/24/2018
Att 7 Privacy Impact Assessment	Att 7_Privacy Impact Assessment.pdf	04/24/2018

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