Information Collection

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

IC 254837 under ICR 202111-0920-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-22HR Development of Messages for the Let's Stop HIV Together National Campaign	Form and Instruction
0920-22HR Att 2 Web-based Survey Screener Att 2 Web-based Survey Screener.docx	Form and Instruction
0920-22HR Att 3 Web-Based Survey Att 3 Web-Based Survey.docx	Form and Instruction
Att 1 Web-Based Consent Form.docx Consent Form	IC Document
Att 4 Screenshots.docx Att 4 Screenshots	IC Document
Att 5 Email Reminder.docx Email Reminder	IC Document
Att 6 Messages.docx Att 6 Messages	IC Document
Att 7 Concepts.docx Att 7 Concepts	IC Document
Supporting Statement A.docx SSA	IC Document
Supporting Statement B.docx SSB	IC Document

IC Title:

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

Agency IC Tracking Number:

0920-22HR

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-22HR	Att 2 Web-based Survey Screener	Att 2 Web-based Survey Screener.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-22HR	Att 3 Web-Based Survey	Att 3 Web-Based Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,500	10,500
Annual IC Time Burden (Hours)	2,450	2,450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form	Att 1 Web-Based Consent Form.docx	07/26/2022
Att 4 Screenshots	Att 4 Screenshots.docx	07/26/2022
Email Reminder	Att 5 Email Reminder.docx	07/26/2022
Att 6 Messages	Att 6 Messages.docx	07/26/2022
Att 7 Concepts	Att 7 Concepts.docx	07/26/2022
SSA	Supporting Statement A.docx	07/26/2022
SSB	Supporting Statement B.docx	07/26/2022

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