Information Collection

Project Engage 2.0: Engaging Gay "Community" Activism for Syphilis Prevention

IC 232126 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 5a-Eligibilty Screener.docx	Other-WORD
Att 5b-Focus Group Guide.docx	Other-WORD
SSA - Project Engage 2.0.docx SupSta A	IC Document
SSB - Project Engage 2.0.docx SupStaB	IC Document
Att 1-PHS Act Legislation.pdf Att 1_Autho Leg	IC Document
Att 2-60 Day FRN.pdf Att 2_60dy FRN	IC Document
Att 3a-Recruitment Flyer.pdf Att 3a_Recruitment Flyer	IC Document
Att 3b-Recruitment Script.docx Att 3b_Recruitment Script	IC Document
Att 4-Consent Form.docx Att 4_Consent Form	IC Document
Att 6-IRB Letter of Approval.pdf Att 6_ IRB Letter of Approval	IC Document
Att 7-CDC Project Determination.pdf Att 7_Project Determination	IC Document

IC Title:

Project Engage 2.0: Engaging Gay "Community" Activism for Syphilis Prevention

Agency IC Tracking Number:

0920-0840 (18ARF)

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
Other-WORD			Att 5a-Eligibilty Screener.docx		No		Fillable Fileable
Other-WORD			Att 5b-Focus Group Guide.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192

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	192	192
Annual IC Time Burden (Hours)	107	107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SupSta A	SSA - Project Engage 2.0.docx	07/13/2018
SupStaB	SSB - Project Engage 2.0.docx	07/13/2018
Att 1_Autho Leg	Att 1-PHS Act Legislation.pdf	07/13/2018
Att 2_60dy FRN	Att 2-60 Day FRN.pdf	07/13/2018
Att 3a_Recruitment Flyer	Att 3a-Recruitment Flyer.pdf	07/13/2018
Att 3b_Recruitment Script	Att 3b-Recruitment Script.docx	07/13/2018
Att 4_Consent Form	Att 4-Consent Form.docx	07/13/2018
Att 6_ IRB Letter of Approval	Att 6-IRB Letter of Approval.pdf	07/13/2018
Att 7_Project Determination	Att 7-CDC Project Determination.pdf	07/13/2018

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