Information Collection

Qualitative Research to Understand Consumer Opinions and Preferences for Emerging HIV Prevention Products among MSM in Atlanta, Houston, and Miami

IC 241844 under ICR 202010-0920-010 · OMB 0920-1091.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Qualitative Research to Understand Consumer Opinions and Preferences for Emerging HIV Prevention Products among MSM in Atlanta, Houston, and Miami	Form and Instruction
Screener Att 2a_Screener.docx	Form and Instruction
Contact Information Form Att 2b_Contact information Form.docx	Form and Instruction
In-depth Interview Guide Att 2c_In Depth Interview Guide.docx	Form and Instruction
Focus Group Guide Att 2d_Focus Group Guide.docx	Form and Instruction
Survey for Participants Currently on PrEP Att 2e_Survey on PrEP.docx	Form and Instruction
Survey for Participants Currently Not on PrEP Att 2f_Survey not on PrEP.docx	Form and Instruction
Att 1_Recruitment Materials.pdf Recruitment Materials	IC Document
Att 3a_Consent for Interview.docx Consent for Interview	IC Document
Att 3b_Consent for Focus Group.docx Consent for Focus Group	IC Document
Att 4_IRB Approval.docx IRB Approval	IC Document
Att 5_Data Use Plan.docx Data Use Plan	IC Document
Att 6_Privacy Impact Assessment.pdf Privacy Impact Assessment	IC Document
Att 7_Product Graphics.docx Product Graphics	IC Document
Att 8_Show Cards.docx Show Cards	IC Document
SSA Final.docx Supporting Statement Part A	IC Document
SSB Final.docx Supporting Statement Part B	IC Document

IC Title:

Agency IC Tracking Number:

0920-20HK-2

IC Status: Unchanged

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?	Electronic Capability
Form and Instruction	n/a	Screener	Att 2a_Screener.docx	No	Paper Only
Form and Instruction	n/a	Contact Information Form	Att 2b_Contact information Form.docx	No	Paper Only
Form and Instruction	n/a	In-depth Interview Guide	Att 2c_In Depth Interview Guide.docx	No	Paper Only
Form and Instruction	n/a	Focus Group Guide	Att 2d_Focus Group Guide.docx	No	Paper Only
Form and Instruction	n/a	Survey for Participants Currently on PrEP	Att 2e_Survey on PrEP.docx	No	Paper Only
Form and Instruction	n/a	Survey for Participants Currently Not on PrEP	Att 2f_Survey not on PrEP.docx	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 01-36-0216, Epidemiologic Studies and Surveillance of Disease Problems, HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	220	220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Materials	Att 1_Recruitment Materials.pdf	05/15/2020
Consent for Interview	Att 3a_Consent for Interview.docx	05/15/2020
Consent for Focus Group	Att 3b_Consent for Focus Group.docx	05/15/2020
IRB Approval	Att 4_IRB Approval.docx	05/15/2020
Data Use Plan	Att 5_Data Use Plan.docx	05/15/2020
Privacy Impact Assessment	Att 6_Privacy Impact Assessment.pdf	05/15/2020
Product Graphics	Att 7_Product Graphics.docx	05/15/2020
Show Cards	Att 8_Show Cards.docx	05/15/2020
Supporting Statement Part A	SSA Final.docx	05/15/2020
Supporting Statement Part B	SSB Final.docx	05/15/2020

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