Information Collection Request
[NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)
ICR 202403-0920-003 · OMB 0920-1402 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1402 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-1402 In-depth Interview – Spanish (Att 6d) |
Form and Instruction | New | Repair queued |
| Form 0920-1402 In-depth Interview – English (Att 6c) |
Form and Instruction | New | Repair queued |
| Form 0920-1402 Consent for qualitative interview - Spanish (Att 5d) |
Form and Instruction | New | Repair queued |
| Form 0920-1402 Consent for qualitative interview– English (Att 5c) |
Form and Instruction | New | Repair queued |
| Form 0920-1402 SHIELD Survey (Spanish) |
Form and Instruction | Modified | Available |
| Form 0920-1402 SHIELD Survey (English) |
Form and Instruction | Modified | Repair queued |
| Form 0920-1402 SHIELD Model Consent (Spanish) |
Form and Instruction | Modified | Repair queued |
| Form 0920-1402 SHIELD Model Consent (English) |
Form and Instruction | Modified | Repair queued |
| Form 0920-1402 SHIELD Model Recruitment Script (Spanish) |
Form and Instruction | Modified | Available |
| Form 0920-1402 SHIELD Recruitment Script (English) |
Form and Instruction | Modified | Repair queued |
 Attachment 8 SHIELD External Consultants.docx |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| Attachment 10 Agreement To Abide by Restrictions on Release of Surveillance Data.docx |
Supplementary Document | Uploaded 2024-03-05 | Missing upstream |
| Attachment 3 SHIELD References.docx |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
 Attachment 11 PIA-No PII Collected.pdf |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| Privacy Act Checklist.docx |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| Attachment 7 SHIELD Project Determination.docx |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| Attachment 2 SHIELD 60-Day FRN.pdf |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| Attachment 1_Authorizing Legislation.pdf |
Supplementary Document | Uploaded 2024-03-05 | Repair queued |
| 30dy2323HK Published.pdf |
Supplementary Document | Uploaded 2023-02-07 | Repair queued |
| SSB Project Shield.docx |
Supporting Statement B | Uploaded 2024-03-05 | Repair queued |
| SSA Project Shield.docx |
Supporting Statement A | Uploaded 2024-03-18 | Repair queued |
| Att 11_Agreement To Abide by Restrictions on Release of Surveillance Data.docx |
Supplementary Document | Uploaded 2023-01-18 | Repair queued |
| Att 10_Assurance of Confidentiality for HIV Surveillance.docx |
Supplementary Document | Uploaded 2023-01-18 | Repair queued |
| Att 9_SHIELD External Consultants.docx |
Supplementary Document | Uploaded 2023-01-18 | Missing upstream |
| Att 7_SHIELD Project Determination.docx |
Supplementary Document | Uploaded 2023-01-12 | Repair queued |
| Att 3_SHIELD References.docx |
Supplementary Document | Uploaded 2023-01-12 | Repair queued |
| Att 1_Authorizing Legislation.pdf |
Supplementary Document | Uploaded 2023-01-12 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 265790 |  In-depth Interview – Spanish (Att 6d) |
Form and Instruction | New | |
| 265789 | In-depth Interview – English (Att 6c) |
Form and Instruction | New | |
| 265788 | Consent for qualitative interview - Spanish (Att 5d) |
Form and Instruction | New | |
| 265787 | Consent for qualitative interview– English (Att 5c) |
Form and Instruction | New | |
| 257895 | SHIELD Survey (Spanish) |
Form and Instruction | Modified | |
| 257894 | SHIELD Survey (English) |
Form and Instruction | Modified | |
| 257893 | SHIELD Model Consent (Spanish) |
Form and Instruction | Modified | |
| 257892 | SHIELD Model Consent (English) |
Form and Instruction | Modified | |
| 257891 | SHIELD Model Recruitment Script (Spanish) |
Form and Instruction | Modified | |
| 257890 | SHIELD Recruitment Script (English) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-1402 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202301-0920-007 |
| Agency Tracking No | 0920-1402 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |