Information Collection Request

Identification of Behavioral and Clinical Predictors of Early HIV Infection (Project DETECT)

ICR 201811-0920-002 · OMB 0920-1100 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Phase 2 Behavioral Survey (screen shots in English) Form and Instruction Modified Available
Phase 2 Behavioral Survey (screen shots in Spanish) Form and Instruction Modified Available
Phase 2 Behavioral Survey (Spanish) Form and Instruction Modified Available
Phase 2 Behavioral Survey (English) Form and Instruction Modified Available
Phase 2 HIV Symptom and Care Survey (screen shots in Spanish) Form and Instruction Modified Available
Phase 2 HIV Symptom and Care Survey (screen shots) Form and Instruction Modified Available
Phase 2 HIV Symptom and Care Survey (Spanish) Form and Instruction Modified Available
Phase 2 HIV Symptom and Care Survey (English) Form and Instruction Modified Available
Phase 1 Enrollment Survey B (screen shots in Spanish) Form and Instruction Modified Available
Phase 1 Enrollment Survey B (screen shots) Form and Instruction Modified Repair queued
Phase 1 Enrollment Survey B (Spanish) Form and Instruction Modified Repair queued
Phase 1 Enrollment Survey B (English) Form and Instruction Modified Available
Phase 1 Enrollment Survey A (screen shots) Form and Instruction Modified Available
Phase 1 Enrollment Survey A (Spanish) Form and Instruction Modified Available
Phase 1 Enrollment Survey A (English) Form and Instruction Modified Available
Att 15_PIA.pdf Supplementary Document Uploaded 2018-11-16 Available
Att 14_Project Determination.pdf Supplementary Document Uploaded 2018-11-16 Available
Att 13_Supplemental Study Information.docx Supplementary Document Uploaded 2018-11-16 Available
Att 5_IRB Approval.pdf Supplementary Document Uploaded 2018-11-16 Available
Att 4_Certificate of Confidentiality.pdf Supplementary Document Uploaded 2018-11-16 Available
Att 3_References.docx Supplementary Document Uploaded 2018-11-16 Available
Att 2_60-Day FRN Published.pdf Supplementary Document Uploaded 2018-11-16 Available
Att 1_Auth Legislation.docx Supplementary Document Uploaded 2018-11-16 Available
Supporting Statement B_11082018.docx Supporting Statement B Uploaded 2018-11-16 Available
Supporting Statement A_11082018.docx Supporting Statement A Uploaded 2018-11-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
218949 Att 10_Phase 2 Consent Other-Consent Form (English) Modified
218948 Phase 1 Consent Other-Consent Form (English) Modified
218947 Phase 2 Behavioral Survey Form and Instruction ModifiedPhase 2 Behavioral Survey (screen shots in English)
218947 Phase 2 Behavioral Survey Form and Instruction ModifiedPhase 2 Behavioral Survey (screen shots in Spanish)
218947 Phase 2 Behavioral Survey Form and Instruction ModifiedPhase 2 Behavioral Survey (Spanish)
218947 Phase 2 Behavioral Survey Form and Instruction ModifiedPhase 2 Behavioral Survey (English)
218946 Phase 2 HIV Symptom and Care Survey Form and Instruction ModifiedPhase 2 HIV Symptom and Care Survey (screen shots in Spanish)
218946 Phase 2 HIV Symptom and Care Survey Form and Instruction ModifiedPhase 2 HIV Symptom and Care Survey (screen shots)
218946 Phase 2 HIV Symptom and Care Survey Form and Instruction ModifiedPhase 2 HIV Symptom and Care Survey (Spanish)
218946 Phase 2 HIV Symptom and Care Survey Form and Instruction ModifiedPhase 2 HIV Symptom and Care Survey (English)
218945 Phase 1 Enrollment Survey B Form and Instruction ModifiedPhase 1 Enrollment Survey B (screen shots in Spanish)
218945 Phase 1 Enrollment Survey B Form and Instruction ModifiedPhase 1 Enrollment Survey B (screen shots)
218945 Phase 1 Enrollment Survey B Form and Instruction ModifiedPhase 1 Enrollment Survey B (Spanish)
218945 Phase 1 Enrollment Survey B Form and Instruction ModifiedPhase 1 Enrollment Survey B (English)
218918 Phase 1 Enrollment Survey A Form and Instruction ModifiedPhase 1 Enrollment Survey A (screen shots)
218918 Phase 1 Enrollment Survey A Form and Instruction ModifiedPhase 1 Enrollment Survey A (Spanish)
218918 Phase 1 Enrollment Survey A Form and Instruction ModifiedPhase 1 Enrollment Survey A (English)

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2022 36 Months From Approved 02/28/2019
4,751 0 4,751
2,110 0 2,110
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
Att 10_Phase 2 Consent
Phase 1 Consent
Phase 1 Enrollment Survey A n/a, n/a, n/a ,   ,  
Phase 1 Enrollment Survey B n/a, n/a, n/a, n/a ,   ,   ,  
Phase 2 Behavioral Survey n/a, n/a, n/a, n/a ,   ,   ,  
Phase 2 HIV Symptom and Care Survey n/a, n/a, n/a, n/a ,   ,   ,  

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 4,751 4,751 0 0 0 0
Annual Time Burden (Hours) 2,110 2,110 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No