Information Collection

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

IC 231185 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.