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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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:

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

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 %

	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

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.