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Federal forms, ICRs, and supporting documents

Information Collection

Assessing the acceptability and adoptability of HIV-1 PrEP technologies among African American women in the SE US

IC 238087 under ICR 202010-0920-010 · OMB 0920-1091.

Documents and Forms
Document Name
Document Type
Form
Other-Interview guide
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Assessing the acceptability and adoptability of HIV-1 PrEP technologies among African American women in the SE US 0920-1091-19BSO
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Screener Att 3a_Study Screener.pdf Yes Yes Fillable Fileable
Form none Contact information Att 3b_Contact Information Form.docx No   Paper Only
Other-Interview guide Att 3c_In-depth Interview Guide.docx Yes No Paper Only
Form none Demographic and behavioral questionnaire Att 3d_Demographic and Behavioral Questionnaire.pdf Yes Yes Fillable Fileable

Health Illness Prevention

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

390 0
   
Individuals or Households
 
   0 %

  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 390 0 0 0 0 390
Annual IC Time Burden (Hours) 98 0 0 0 0 98
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A SS A.docx 10/10/2019
Supporting Statement B SS B.docx 10/10/2019
Authorizing legislation Att 1_Auth Legislation (1).pdf 10/10/2019
Authorizing legislation Att 1_Auth Legislation.pdf 10/10/2019
Recruitment flyer Att 2_Recruitment Flyer.pdf 10/10/2019
Consent Att 4_Written Informed Consent Form.docx 10/10/2019
IRB Approval Att 5_CDC IRB Approval.docx 10/10/2019
Data use plan Att 6_Data Use Plan.doc 10/10/2019
PIA Att 7_iQualR PIA_signed.pdf 10/10/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.