Information Collection

Assessing the acceptability and adoptability of HIV-1 PrEP technologies among African American women in the SE US

IC 238087 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assessing the acceptability and adoptability of HIV-1 PrEP technologies among African American women in the SE US	Form
Att 3c_In-depth Interview Guide.docx	Other-Interview guide
Screener Att 3a_Study Screener.pdf	Form
Contact information Att 3b_Contact Information Form.docx	Form
Demographic and behavioral questionnaire Att 3d_Demographic and Behavioral Questionnaire.pdf	Form
SS A.docx Supporting Statement A	IC Document
SS B.docx Supporting Statement B	IC Document
Att 1_Auth Legislation (1).pdf Authorizing legislation	IC Document
Att 1_Auth Legislation.pdf Authorizing legislation	IC Document
Att 2_Recruitment Flyer.pdf Recruitment flyer	IC Document
Att 4_Written Informed Consent Form.docx Consent	IC Document
Att 5_CDC IRB Approval.docx IRB Approval	IC Document
Att 6_Data Use Plan.doc Data use plan	IC Document
Att 7_iQualR PIA_signed.pdf PIA	IC Document

IC Title:

Assessing the acceptability and adoptability of HIV-1 PrEP technologies among African American women in the SE US

Agency IC Tracking Number:

0920-1091-19BSO

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?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screener	Att 3a_Study Screener.pdf	Yes	Yes	Fillable Fileable
Form	none	Contact information	Att 3b_Contact Information Form.docx	No		Paper Only
Other-Interview guide			Att 3c_In-depth Interview Guide.docx	Yes	No	Paper Only
Form	none	Demographic and behavioral questionnaire	Att 3d_Demographic and Behavioral Questionnaire.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 390

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	390	390
Annual IC Time Burden (Hours)	98	98
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SS A.docx	10/10/2019
Supporting Statement B	SS B.docx	10/10/2019
Authorizing legislation	Att 1_Auth Legislation (1).pdf	10/10/2019
Authorizing legislation	Att 1_Auth Legislation.pdf	10/10/2019
Recruitment flyer	Att 2_Recruitment Flyer.pdf	10/10/2019
Consent	Att 4_Written Informed Consent Form.docx	10/10/2019
IRB Approval	Att 5_CDC IRB Approval.docx	10/10/2019
Data use plan	Att 6_Data Use Plan.doc	10/10/2019
PIA	Att 7_iQualR PIA_signed.pdf	10/10/2019

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