Positive Health Check Evaluation Trial

ICR 201706-0920-012

OMB: 0920-1211

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
New
Form and Instruction
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Supplementary Document
2017-06-30
Supplementary Document
2017-12-13
Supplementary Document
2017-12-13
Supplementary Document
2017-06-30
Supplementary Document
2017-06-30
Supplementary Document
2017-12-13
Supplementary Document
2017-06-30
Supplementary Document
2017-06-30
Supporting Statement B
2017-12-15
Supporting Statement A
2017-12-15
ICR Details
0920-1211 201706-0920-012
Historical Active
HHS/CDC 0920-17CA
Positive Health Check Evaluation Trial
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 12/22/2017
Retrieve Notice of Action (NOA) 07/05/2017
  Inventory as of this Action Requested Previously Approved
12/31/2020 36 Months From Approved
1,077 0 0
419 0 0
0 0 0

The purpose of this data collection is to evaluate the effectiveness of Positive Health Check (PHC), an online tool created by RTI and CDC that delivers tailored evidence based prevention messages to HIV positive patients, on improving clinical outcomes and retention in care of HIV positive patients with unsuppressed viral loads.

US Code: 42 USC 241 Name of Law: U.S. PHSA
  
None

Not associated with rulemaking

  81 FR 76590 11/03/2016
82 FR 29861 06/30/2017
No

  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 1,077 0 0 1,077 0 0
Annual Time Burden (Hours) 419 0 0 419 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Submission of 0920-17CA is a New ICR.

$1,755,401
No
    Yes
    No
No
No
No
Uncollected
Renita Macaluso 770 488-6458 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/05/2017


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