Information Collection Request

Network Epidemiology of Syphilis Transmission (NEST)

ICR 201808-0920-013 · OMB 0920-1248 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
NEST - Smartphone Survey 07DEC2018 Form and Instruction New Available
NEST - Questionnaire and Data Elements Form and Instruction New Available
NEST Data Elements Summary and Source 07DEC2018 Form and Instruction New Available
Eligibility Screener Form and Instruction New Available
Att 3b_Data elements summary and source_11092018.docx Supplementary Document Uploaded 2018-12-07 Available
CDC Syphilis SSB_11092018.docx Supporting Statement B Uploaded 2018-12-07 Available
CDC Syphilis SSA_11092018.doc Supporting Statement A Uploaded 2018-12-07 Available
OSU IRB approval_July 2018.pdf Supplementary Document Uploaded 2018-09-07 Available
Baltimore_IRB approval letter.pdf Supplementary Document Uploaded 2018-09-07 Available
Att 10 PIA NEST.pdf Supplementary Document Uploaded 2018-09-07 Available
Att 8_Non research determination.pdf Supplementary Document Uploaded 2018-09-07 Available
Att 7_Project Personnel.doc Supplementary Document Uploaded 2018-09-07 Available
Att 6_Consent Form_11092018.doc Supplementary Document Uploaded 2018-12-07 Available
Att 2A_Public Comments.pdf Supplementary Document Uploaded 2018-09-07 Available
Att 1_Public Health Service Act.pdf Supplementary Document Uploaded 2018-09-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
232949 Smartphone Survey - Study Participant Form and Instruction NewNEST - Smartphone Survey 07DEC2018
232948 NEST Survey - Study Participant Form and Instruction NewNEST - Questionnaire and Data Elements
232947 NEST Data Elements - Site Data Manager Form and Instruction NewNEST Data Elements Summary and Source 07DEC2018
232946 Screener Form and Instruction NewEligibility Screener

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2021 36 Months From Approved
41,955 0 0
6,828 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
NEST Data Elements - Site Data Manager NA
NEST Survey - Study Participant NA
Screener NA
Smartphone Survey - Study Participant NA

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 41,955 0 0 41,955 0 0
Annual Time Burden (Hours) 6,828 0 0 6,828 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No