OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"

IC 235907 under ICR 202010-0920-010 · OMB 0920-1091.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1091
HIV Prevention and Treatment Services among Young Men of Color who Have Sex with Men (YMSM of Color) and Young Transgender Persons of Color (YTG of Color) in the Deep South"		 Form
0920-1091 Deep South Client Screener (English)
Att 3a_Deep South Client Screener 3 26 2019.docx 		Form
0920-1091 Deep South CBO Client Interview Guide
Att 3b_Deep South Client Interview Guide 3 26 2019.docx 		Form and Instruction
0920-1091 Deep South Staff Interview Guide
Att 3c_Deep South Staff Interview Guide.docx 		Form and Instruction
Att 1_Deep South Recruitment Flyers.pdf
Att 1_ Deep South Recruitment Flyers		IC Document
Att 2_Deep South Informed Consent Forms.docx
Att 2_Deep South Informed Consent		IC Document
Att 4a_CDC IRB Approval Protocol 7152 Approval.docx
Att 4a _CDC IRB Approval		IC Document
Att 4b_Emory U IRB Determination.pdf
Att 4b_Emory IRB Determination		IC Document
Att 5_Deep South Data Use Plan.doc
Att 5_Data Use Plan		IC Document
Att 6_Privacy Impact Assessment Approval.pdf
Att 6_Privacy Impact Assessment		IC Document
2018 iQualR PIA_signed 3 26 2019.pdf
2018 iQualR PIA		IC Document
SSA - HIV Prevention and Treatment (YMSM of Color) (YTG of Color) 0920-1091 3 26 2019.docx
Supporting Statement A		IC Document
SS B.docx
Supporting Statement B		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1091 Deep South Client Screener (English) Att 3a_Deep South Client Screener 3 26 2019.docx No   Fillable Printable
Form and Instruction 0920-1091 Deep South CBO Client Interview Guide Att 3b_Deep South Client Interview Guide 3 26 2019.docx No   Paper Only
Form and Instruction 0920-1091 Deep South Staff Interview Guide Att 3c_Deep South Staff Interview Guide.docx No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 444 0 0 0 0 444
Annual IC Time Burden (Hours) 177 0 0 0 0 177
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Att 1_ Deep South Recruitment Flyers Att 1_Deep South Recruitment Flyers.pdf 04/30/2019
Att 2_Deep South Informed Consent Att 2_Deep South Informed Consent Forms.docx 04/30/2019
Att 4a _CDC IRB Approval Att 4a_CDC IRB Approval Protocol 7152 Approval.docx 04/30/2019
Att 4b_Emory IRB Determination Att 4b_Emory U IRB Determination.pdf 04/30/2019
Att 5_Data Use Plan Att 5_Deep South Data Use Plan.doc 04/30/2019
Att 6_Privacy Impact Assessment Att 6_Privacy Impact Assessment Approval.pdf 04/30/2019
2018 iQualR PIA 2018 iQualR PIA_signed 3 26 2019.pdf 04/30/2019
Supporting Statement A SSA - HIV Prevention and Treatment (YMSM of Color) (YTG of Color) 0920-1091 3 26 2019.docx 04/30/2019
Supporting Statement B SS B.docx 04/30/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.