Information Collection

HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"

IC 235907 under ICR 201808-0920-012 · OMB 0920-1091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1091 can be found here:

2020-11-12 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1091 Deep South Client Screener (English) HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"	Form
Form 0920-1091 Deep South CBO Client Interview Guide HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"	Form and Instruction
Form 0920-1091 Deep South Staff Interview Guide HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"	Form and Instruction
0920-1091 Deep South Client Screener (English) Att 3a_Deep South Client Screener 3 26 2019.docx	Form
0920-1091 Deep South CBO Client Interview Guide Att 3b_Deep South Client Interview Guide 3 26 2019.docx	Form and Instruction
0920-1091 Deep South Staff Interview Guide Att 3c_Deep South Staff Interview Guide.docx	Form and Instruction
Att 1_Deep South Recruitment Flyers.pdf Att 1_ Deep South Recruitment Flyers	IC Document
Att 2_Deep South Informed Consent Forms.docx Att 2_Deep South Informed Consent	IC Document
Att 4a_CDC IRB Approval Protocol 7152 Approval.docx Att 4a _CDC IRB Approval	IC Document
Att 4b_Emory U IRB Determination.pdf Att 4b_Emory IRB Determination	IC Document
Att 5_Deep South Data Use Plan.doc Att 5_Data Use Plan	IC Document
Att 6_Privacy Impact Assessment Approval.pdf Att 6_Privacy Impact Assessment	IC Document
2018 iQualR PIA_signed 3 26 2019.pdf 2018 iQualR PIA	IC Document
SSA - HIV Prevention and Treatment (YMSM of Color) (YTG of Color) 0920-1091 3 26 2019.docx Supporting Statement A	IC Document
SS B.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"

Agency IC Tracking Number:

0920-1091-19ATS

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	Available Electronically?	Electronic Capability
Form	0920-1091	Deep South Client Screener (English)	Att 3a_Deep South Client Screener 3 26 2019.docx	No	Fillable Printable
Form and Instruction	0920-1091	Deep South CBO Client Interview Guide	Att 3b_Deep South Client Interview Guide 3 26 2019.docx	No	Paper Only
Form and Instruction	0920-1091	Deep South Staff Interview Guide	Att 3c_Deep South Staff Interview Guide.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 444

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	444	444
Annual IC Time Burden (Hours)	177	177
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 1_ Deep South Recruitment Flyers	Att 1_Deep South Recruitment Flyers.pdf	04/30/2019
Att 2_Deep South Informed Consent	Att 2_Deep South Informed Consent Forms.docx	04/30/2019
Att 4a _CDC IRB Approval	Att 4a_CDC IRB Approval Protocol 7152 Approval.docx	04/30/2019
Att 4b_Emory IRB Determination	Att 4b_Emory U IRB Determination.pdf	04/30/2019
Att 5_Data Use Plan	Att 5_Deep South Data Use Plan.doc	04/30/2019
Att 6_Privacy Impact Assessment	Att 6_Privacy Impact Assessment Approval.pdf	04/30/2019
2018 iQualR PIA	2018 iQualR PIA_signed 3 26 2019.pdf	04/30/2019
Supporting Statement A	SSA - HIV Prevention and Treatment (YMSM of Color) (YTG of Color) 0920-1091 3 26 2019.docx	04/30/2019
Supporting Statement B	SS B.docx	04/30/2019

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