Information Collection

Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St

IC 244054 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⚠️ Notice: This information collection may be referencing outdated material.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
Screener - screenshots Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St	Form
Contact information form Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St	Form
Demographic behavioral CAPI - screenshots Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St	Form
Att 3c_IDI Guide and Showcards_new.docx	Other-Interview guide
Screener - screenshots Att 3a_Screener CAPI Screenshots_new.pdf	Form
Contact information form Att 3b_Contact Information Form_new.docx	Form
Demographic behavioral CAPI - screenshots Att 3d_Demographic Behavioral CAPI Screenshots_new.pdf	Form
Att 1_Auth Legislation.pdf Authorizing legislation	IC Document
Att 2_Recruitment Flyer_new.pdf Recruitment flyer	IC Document
Att 4 Informed Consent_new.docx Consent	IC Document
Att 5_CDC IRB Approval.docx IRB Approval	IC Document
Att 6_Data Use Plan.docx Data use plan	IC Document
Att 7_iQualR PIA_signed.pdf PIA	IC Document
Explanation of COVID related GenIC Change.docx Explanation of need for change of procedures	IC Document
SS B_Clean.docx Supporting statement B	IC Document
SS A_Clean11.10.20.docx SSA	IC Document
Att 5a_ Amendment IRB Approval 1 Protocol #7224 (002).pdf IRB Amendment	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Assessing the acceptability and adoptability of HIV-1 pre-exposure prophylaxis (PrEP) technologies with and without contraceptive formulation among African American women in the southeastern United St

Agency IC Tracking Number:

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 - screenshots	Att 3a_Screener CAPI Screenshots_new.pdf	Yes	Yes	Fillable Fileable
Form	none	Contact information form	Att 3b_Contact Information Form_new.docx	Yes	Yes	Fillable Fileable
Other-Interview guide			Att 3c_IDI Guide and Showcards_new.docx	Yes	Yes	Fillable Fileable
Form	none	Demographic behavioral CAPI - screenshots	Att 3d_Demographic Behavioral CAPI Screenshots_new.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 390

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

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
Authorizing legislation	Att 1_Auth Legislation.pdf	10/14/2020
Recruitment flyer	Att 2_Recruitment Flyer_new.pdf	10/14/2020
Consent	Att 4 Informed Consent_new.docx	10/14/2020
IRB Approval	Att 5_CDC IRB Approval.docx	10/14/2020
Data use plan	Att 6_Data Use Plan.docx	10/14/2020
PIA	Att 7_iQualR PIA_signed.pdf	10/14/2020
Explanation of need for change of procedures	Explanation of COVID related GenIC Change.docx	10/14/2020
Supporting statement B	SS B_Clean.docx	10/14/2020
SSA	SS A_Clean11.10.20.docx	11/12/2020
IRB Amendment	Att 5a_ Amendment IRB Approval 1 Protocol #7224 (002).pdf	11/12/2020

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