[NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1402 Attachment 6D SHIELD Qualitative IDI Guide (Spanish)	Form and Instruction	Unchanged	Available
Form 0920-1402 In-depth Interview – Spanish (Att 6d)	Form and Instruction	Unchanged	Missing upstream
Form 0920-1402 Attachment 6C SHIELD Qualitative IDI Guide (English)	Form and Instruction	Modified	Available
Form 0920-1402 In-depth Interview – English (Att 6c)	Form and Instruction	Modified	Missing upstream
Form 0920-1402 Attachment 5D SHIELD QUAL Model Consent (Spanish)	Form and Instruction	Unchanged	Available
Form 0920-1402 Consent for qualitative interview - Spanish (Att 5d)	Form and Instruction	Unchanged	Repair queued
Form 0920-1402 Attachment 5c SHIELD Model Qual Consent (English)	Form and Instruction	Unchanged	Available
Form 0920-1402 Consent for qualitative interview– English (Att 5c)	Form and Instruction	Unchanged	Repair queued
Form 0920-1402 Attachment 6B SHIELD Survey SPANISH	Form and Instruction	Modified	Available
Form 0920-1402 SHIELD Survey (Spanish)	Form and Instruction	Modified	Repair queued
Form 0920-1402 Attachment 6A SHIELD Survey (English)	Form and Instruction	Modified	Repair queued
Form 0920-1402 SHIELD Survey (English)	Form and Instruction	Modified	Repair queued
Form 0920-1402 Attachment 5B SHIELD Model Consent (Spanish)	Form and Instruction	Unchanged	Available
Form 0920-1402 SHIELD Model Consent (Spanish)	Form and Instruction	Unchanged	Repair queued
Form 0920-1402 Attachment 5A SHIELD Model and Actual Consent (English)	Form and Instruction	Unchanged	Available
Form 0920-1402 SHIELD Model Consent (English)	Form and Instruction	Unchanged	Repair queued
Form 0920-1402 Attachment 4b SHIELD Quantitative Recruitment Script (Spanish)	Form and Instruction	Unchanged	Available
Form 0920-1402 SHIELD Model Recruitment Script (Spanish)	Form and Instruction	Unchanged	Repair queued
Form 0920-1402 Attachment 4a SHIELD Quantitative Recruitment Script (English)	Form and Instruction	Unchanged	Available
Form 0920-1402 SHIELD Recruitment Script (English)	Form and Instruction	Unchanged	Repair queued
Justification Memo for Nonsubstantive Change Req_0920-1402 SHIELD.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-28	Repair queued
Justification Memo for Nonsubstantive Change Req_0920-1402 SHIELD.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-28	Repair queued
Attachment 8 SHIELD External Consultants.docx	Supplementary Document	Uploaded 2024-03-05	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_clean.docx	Supplementary Document	Uploaded 2025-03-28	Repair queued
Attachment 10 Agreement To Abide by Restrictions on Release of Surveillance Data_clean.docx	Supplementary Document	Uploaded 2025-03-28	Repair queued
Attachment 3 SHIELD References.docx	Supplementary Document	Uploaded 2024-03-05	Repair queued
Attachment 3 SHIELD References.docx	Supplementary Document	Uploaded 2024-03-05	Available
Attachment 11 PIA-No PII Collected.pdf	Supplementary Document	Uploaded 2024-03-05	Repair queued
Attachment 11 PIA-No PII Collected.pdf	Supplementary Document	Uploaded 2024-03-05	Missing upstream
Privacy Act Checklist.docx	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 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 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
Attachment 1_Authorizing Legislation.pdf	Supplementary Document	Uploaded 2024-03-05	Repair queued
SSB Project Shield_clean.docx	Supporting Statement B	Uploaded 2025-03-28	Repair queued
SSB Project Shield_clean.docx	Supporting Statement B	Uploaded 2025-03-28	Repair queued
SSA Project Shield_clean.docx	Supporting Statement A	Uploaded 2025-03-28	Repair queued
SSA Project Shield_clean.docx	Supporting Statement A	Uploaded 2025-03-28	Repair queued
Attachment 9 Assurance of Confidentiality for HIV Surveillance.docx	Supplementary Document	Uploaded 2025-03-24	Repair queued
Attachment 9 Assurance of Confidentiality for HIV Surveillance.docx	Supplementary Document	Uploaded 2025-03-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
265790	In-depth Interview – Spanish (Att 6d)	Form and Instruction	Unchanged	Attachment 6D SHIELD Qualitative IDI Guide (Spanish)
265790	In-depth Interview – Spanish (Att 6d)	Form and Instruction	Unchanged
265789	In-depth Interview – English (Att 6c)	Form and Instruction	Modified	Attachment 6C SHIELD Qualitative IDI Guide (English)
265789	In-depth Interview – English (Att 6c)	Form and Instruction	Modified
265788	Consent for qualitative interview - Spanish (Att 5d)	Form and Instruction	Unchanged	Attachment 5D SHIELD QUAL Model Consent (Spanish)
265788	Consent for qualitative interview - Spanish (Att 5d)	Form and Instruction	Unchanged
265787	Consent for qualitative interview– English (Att 5c)	Form and Instruction	Unchanged	Attachment 5c SHIELD Model Qual Consent (English)
265787	Consent for qualitative interview– English (Att 5c)	Form and Instruction	Unchanged
257895	SHIELD Survey (Spanish)	Form and Instruction	Modified	Attachment 6B SHIELD Survey SPANISH
257895	SHIELD Survey (Spanish)	Form and Instruction	Modified
257894	SHIELD Survey (English)	Form and Instruction	Modified	Attachment 6A SHIELD Survey (English)
257894	SHIELD Survey (English)	Form and Instruction	Modified
257893	SHIELD Model Consent (Spanish)	Form and Instruction	Unchanged	Attachment 5B SHIELD Model Consent (Spanish)
257893	SHIELD Model Consent (Spanish)	Form and Instruction	Unchanged
257892	SHIELD Model Consent (English)	Form and Instruction	Unchanged	Attachment 5A SHIELD Model and Actual Consent (English)
257892	SHIELD Model Consent (English)	Form and Instruction	Unchanged
257891	SHIELD Model Recruitment Script (Spanish)	Form and Instruction	Unchanged	Attachment 4b SHIELD Quantitative Recruitment Script (Spanish)
257891	SHIELD Model Recruitment Script (Spanish)	Form and Instruction	Unchanged
257890	SHIELD Recruitment Script (English)	Form and Instruction	Unchanged	Attachment 4a SHIELD Quantitative Recruitment Script (English)
257890	SHIELD Recruitment Script (English)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1402	ICR Reference No: 202503-0920-026
Status: Historical Active	Previous ICR Reference No: 202403-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0056
Title: [NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	05/31/2027	05/31/2027
Responses	7,700	0	7,700
Time Burden (Hours)	3,074	0	3,074
Cost Burden (Dollars)	0	0	0

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Abstract: Project SHIELD (Surveillance of HIV-related service barriers among individuals with early or late HIV diagnoses) is a project to assess barriers and facilitators to HIV testing and HIV prevention strategies, including PrEP, with the goal of prioritizing interventions and efforts to prevent infections and facilitate early diagnosis and linkage to care. The enhanced surveillance will be conducted in collaboration with four US health departments who will use their HIV surveillance data to generate lists of potentially eligible participants. Eligible participants will be interviewed by a contractor funded by CDC. This change request complies with recent executive orders.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 69640	10/06/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 7711	02/05/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Consent for qualitative interview - Spanish (Att 5d)	0920-1402	Attachment 5D SHIELD QUAL Model Consent (Spanish)
Consent for qualitative interview– English (Att 5c)	0920-1402	Attachment 5c SHIELD Model Qual Consent (English)
In-depth Interview – English (Att 6c)	0920-1402	Attachment 6C SHIELD Qualitative IDI Guide (English)
In-depth Interview – Spanish (Att 6d)	0920-1402	Attachment 6D SHIELD Qualitative IDI Guide (Spanish)
SHIELD Model Consent (English)	0920-1402	Attachment 5A SHIELD Model and Actual Consent (English)
SHIELD Model Consent (Spanish)	0920-1402	Attachment 5B SHIELD Model Consent (Spanish)
SHIELD Model Recruitment Script (Spanish)	0920-1402	Attachment 4b SHIELD Quantitative Recruitment Script (Spanish)
SHIELD Recruitment Script (English)	0920-1402	Attachment 4a SHIELD Quantitative Recruitment Script (English)
SHIELD Survey (English)	0920-1402	Attachment 6A SHIELD Survey (English)
SHIELD Survey (Spanish)	0920-1402	Attachment 6B SHIELD Survey SPANISH

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,700	7,700	0	0	0	0
Annual Time Burden (Hours)	3,074	3,074	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The purpose of this data collection is to describe the health-related behaviors, experiences, and needs of adults diagnosed with HIV in the United States. CDC is requesting approval for 3,074 burden hours and three years of approval.

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Annual Cost to Federal Government: $2,370,027

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/28/2025

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