Information Collection Request
[NCHHSTP] _Expanding PrEP in Communities of Color (EPICC) (24BY)
ICR 202401-0920-004 · OMB 0920-1423 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1423 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-22GA Aims 1&2 Clinic Assessment (every 6 months) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aims 1&2 Clinic Assessment (Baseline & Final) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2b Provider Focus Group Guide |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2b Provider Pre-Focus Group Survey |
Form and Instruction | Unchanged | Missing upstream |
| Form 0920-22GA Aim 2b Provider Focus Group Contact Information |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2b Provider Focus Group Screener |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2a Cohort Exit Interview (English/Spanish) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2a Cohort Blood Collection Instructions (English/Spanish) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2a Cohort App Setup (English/Spanish) |
Form and Instruction | Unchanged | Repair queued |
| Form MOD00003217 Aim 2a Cohort Follow Up Survey (English/Spanish) |
Form and Instruction | Modified | Repair queued |
| Form 0920-22GA Aim 2a Cohort Baseline Survey (English/Spanish) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2a Cohort HIPAA Form (English & Spanish) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 2a Cohort Contact Information (English/Spanish) |
Form and Instruction | Unchanged | Available |
| Form MOD00003217 Aim 2a Cohort Screener (English/Spanish) |
Form and Instruction | Modified | Repair queued |
| Form 0920-22GA Aim 1 Provider Patient Interaction (Baseline and Final) |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 1 Provider Post-Training Survey |
Form and Instruction | Unchanged | Repair queued |
| Form MOD00003217 Aim 1 Provider Pre- Training Survey |
Form and Instruction | Modified | Repair queued |
| Form 0920-22GA Aim 1 Provider Training Contact Information |
Form and Instruction | Unchanged | Repair queued |
| Form 0920-22GA Aim 1 Provider Training Screener |
Form and Instruction | Unchanged | Repair queued |
 Justification for Nonmaterial Nonsubstantive Change to an OMB Approved Information Collection.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-01-05 | Repair queued |
| Att 10_Summary of Changes Table (24BY).docx |
Supplementary Document | Uploaded 2024-01-05 | Repair queued |
 Att_6l_Wake_County_Health_Department_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6k_Baylor_Harris_Health_PrEP_Clinic_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6j_Bliss_Healthcare_Services_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6i_USF_Ybor_Youth_Clinic_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6h_Five_Horizons_Health_Services_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6g_Amity_Medical_Group_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6f_Childrens_Hospital_of_Philadelphia_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6e_Childrens_Hospital_Montefiore_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6d_Cook_County_HHS_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-31 | Repair queued |
| Att_6b_University_of_North_Carolina_Chapel_Hill_IRB_agreement[1].pdf |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| Att_6a_Florida_State_University_IRB_Letter_of_Approval[1].pdf |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| Att_9_Provider_Training_Summary[1].docx |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| Att_7_Data_Use_Plan_EPICC[1].docx |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| Att_1_Auth_Legislation[1].docx |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| 30_Day_FRN_EPICC[1].docx |
Supplementary Document | Uploaded 2023-10-30 | Repair queued |
| SSB[1].docx |
Supporting Statement B | Uploaded 2023-10-30 | Repair queued |
| SSA.docx |
Supporting Statement A | Uploaded 2023-10-30 | Repair queued |
IC Document Collections
Aims 1&2 Clinic Assessment (every 6 months)ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-1423 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202309-0920-011 |
| Agency Tracking No | 0920-1423-24BY |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |