Sexual Health Study for Gay and Bisexual Men

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.