Information Collection

Development of Messages for the "Let's Stop HIV Together" National Campaign

IC 244026 under ICR 201809-0920-008 · OMB 0920-0920.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Development of Messages for the "Let's Stop HIV Together" National Campaign	Form and Instruction
Att 2 Web-based Survey Screener_2020-08-20.docx	Other-WORD version of screening ques
Att 3 Web-Based Survey.docx	Other-WORD version of survey questio
Screenshots of Screener and Survey Instrument Att 4 Screenshots of Screener and Survey_2020-10-20.docx	Form and Instruction
Supporting Statement A_GenIC-Together-Prevention_12-9-2020.docx Supporting Statement Part A	IC Document
Supporting Statement B_GenIC-Together-Prevention_12-3-2020.docx Supporting Statement Part B	IC Document
Att 1 Consent Form.docx Consent Form (consent is embedded in the screenshots)	IC Document
Att 5 Web-based Email Reminder.docx Email Reminder	IC Document
Att 6 2020 PD Approval_7.16.20.pdf Project Determination: IRB Approval Not Required	IC Document

IC Title:

Development of Messages for the "Let's Stop HIV Together" National Campaign

Agency IC Tracking Number:

0920-21AH

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 and Instruction	n/a	Screenshots of Screener and Survey Instrument	Att 4 Screenshots of Screener and Survey_2020-10-20.docx	Yes	Yes	Fillable Fileable
Other-WORD version of screening questions to facilitate review			Att 2 Web-based Survey Screener_2020-08-20.docx	No		Paper Only
Other-WORD version of survey questions to facilitate review			Att 3 Web-Based Survey.docx	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,340

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	1,340	1,340
Annual IC Time Burden (Hours)	545	545
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	Supporting Statement A_GenIC-Together-Prevention_12-9-2020.docx	12/09/2020
Supporting Statement Part B	Supporting Statement B_GenIC-Together-Prevention_12-3-2020.docx	12/09/2020
Consent Form (consent is embedded in the screenshots)	Att 1 Consent Form.docx	10/20/2020
Email Reminder	Att 5 Web-based Email Reminder.docx	10/22/2020
Project Determination: IRB Approval Not Required	Att 6 2020 PD Approval_7.16.20.pdf	10/22/2020

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