Information Collection

Sexual Health Study for Gay and Bisexual Men

IC 233703 under ICR 201806-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0572 Sexual Health Study for Gay and Bisexual Men	Form and Instruction
0920-0572 Screener - Understanding Sexual Health Messaging among M ATTACHMENT 2 ScreeningForm_noHIV 25OCT2019.docx	Form and Instruction
0920-0572 Focus Group Moderator Guide - Sexual Health Study for Ga ATTACHMENT 4 FocusGroupModeratorGuide_8.31.2018.docx	Form and Instruction
18_294579-Shigella_Infographic_MSM.pdf Shigella Infographic	IC Document
ATTACHMENT 1 Recruitment Script.docx Recruitment Script	IC Document
ATTACHMENT 3 InformedConsent.docx Informed Consent - GSU	IC Document
ATTACHMENT 5 GSU IRB Approval.pdf IRB Approval - GSU	IC Document
GSU Outcome_Letter Sept 2018.pdf IRB Amendment Approval - GSU	IC Document
Shigella_CDC_Concept_1.JPG Shigella - Concept 1	IC Document
Shigella_CDC_Concept_1A.JPG Shigella - Concept 1A	IC Document
Shigella_CDC_Concept_2.jpg Shigella - Concept 2	IC Document
Shigella_CDC_Concept_3.jpg Shigella - Concept 3	IC Document
Expedited Review Form_MSM_Shigella_MessageTesting 31OCT2018.pdf Expedited Review Form_HMTS GenIC Request	IC Document

IC Title:

Sexual Health Study for Gay and Bisexual Men

Agency IC Tracking Number:

0920-0572-19AE

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 and Instruction	0920-0572	Screener - Understanding Sexual Health Messaging among Men who have Sex with Men	ATTACHMENT 2 ScreeningForm_noHIV 25OCT2019.docx	NA	No		Fillable Fileable
Form and Instruction	0920-0572	Focus Group Moderator Guide - Sexual Health Study for Gay and Bisexual Men	ATTACHMENT 4 FocusGroupModeratorGuide_8.31.2018.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 460

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	460	460
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Shigella Infographic	18_294579-Shigella_Infographic_MSM.pdf	10/26/2018
Recruitment Script	ATTACHMENT 1 Recruitment Script.docx	10/26/2018
Informed Consent - GSU	ATTACHMENT 3 InformedConsent.docx	10/26/2018
IRB Approval - GSU	ATTACHMENT 5 GSU IRB Approval.pdf	10/26/2018
IRB Amendment Approval - GSU	GSU Outcome_Letter Sept 2018.pdf	10/26/2018
Shigella - Concept 1	Shigella_CDC_Concept_1.JPG	10/26/2018
Shigella - Concept 1A	Shigella_CDC_Concept_1A.JPG	10/26/2018
Shigella - Concept 2	Shigella_CDC_Concept_2.jpg	10/26/2018
Shigella - Concept 3	Shigella_CDC_Concept_3.jpg	10/26/2018
Expedited Review Form_HMTS GenIC Request	Expedited Review Form_MSM_Shigella_MessageTesting 31OCT2018.pdf	10/31/2018

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