HIV Knowledge, Beliefs, Attitudes, and Practices of Providers in the Southeast

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Provider Follow-up Survey	Form	New	Available
Provider Baseline Survey	Form	New	Available
Att8_Altarium Secured Network_27jan2017.docx	Supplementary Document	Uploaded 2017-01-31	Available
Att7_Examples of CE Courses.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att6 IRB Approval Ltr.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5i_Post-Test Survey Email Reminder.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5h_Phone Reminder Script.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5g_Postcard Reminder.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5f_Email Reminder.docx	Supplementary Document	Uploaded 2017-01-31	Available
Att5e_Consent Cover Letter.docx	Supplementary Document	Uploaded 2017-01-31	Available
Att5d_Email Invitation Letter.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5c_Postal Invitation Letter.docx	Supplementary Document	Uploaded 2017-01-31	Available
Att5b_Phone Recruitment Script.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att5a_Recruitment Email.docx	Supplementary Document	Uploaded 2017-01-31	Repair queued
Att4_CE Materials Email.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att2a_Public Comment.docx	Supplementary Document	Uploaded 2016-07-21	Available
Att2_60 Day FRN.pdf	Supplementary Document	Uploaded 2016-07-21	Available
Att 1_Auth Legislation.docx	Supplementary Document	Uploaded 2016-07-21	Available
Sup Statement B.docx	Supporting Statement B	Uploaded 2016-07-21	Available
Sup Statement A_CLEAN_OMB_29Jan2017.docx	Supporting Statement A	Uploaded 2017-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222569	Provider Follow-up Survey	Form	New
222568	Provider Baseline Survey	Form	New

ICR Details

OMB Control No: 0920-1160	ICR Reference No: 201607-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16VB
Title: HIV Knowledge, Beliefs, Attitudes, and Practices of Providers in the Southeast
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/01/2017
	Date Received in OIRA: 07/28/2016
Terms of Clearance: Approved consistent with the understanding that any incentives offered to respondents will be provided conditional to completion of the survey (i.e., after the survey is completed).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	12 Months From Approved
Responses	2,741	0	0
Time Burden (Hours)	1,219	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the project is to address disparities and missed opportunities for HIV prevention between primary providers and their clients by assessing the knowledge, beliefs, attitudes, and practices of primary health care providers according to HIV prevention domains in 6 MSAs in the Southeast US.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 15725	03/24/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 48798	07/26/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Provider Baseline Survey	none, none	Baseline survey ,   Baseline Screener and Survey Screenshots
Provider Follow-up Survey	none, none	Follow-up Survey ,   Follow-up Survey Screenshots

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,741	0	0	2,741	0	0
Annual Time Burden (Hours)	1,219	0	0	1,219	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $349,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/28/2016

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