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

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.