OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Intervention Trials To Retain HIV-Positive Patients in Medical Care

OMB 0915-0330 · HHS/HSA.

OMB 0915-0330

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form Tab 10 Intervention Trials- Contact/Locator InformationForm and Instruction
Form Tab 9 Intervention Trials- Retention Specialist/Patient Navigator Encounter FormForm and Instruction
Form Tab 8 Intervention Trials- Retention Risk ScreenerForm and Instruction
Form Tab 7 Intervention Trials- Patient Baseline SurveyForm and Instruction
Form Tab 6 Intervention Trials- Patient Eligibility ScreenerForm
Form Tab 4 Intervention Trials- Patient Exit SurveyForm and Instruction
Form Tab 3 Intervention Trials- Clinic Staff SurveyForm and Instruction
Form Tab 2 Intervention Trials- Primary Care Provider SurveyForm and Instruction
Tab 16 Informed Consent.doc Supplementary Document
11.20.09 MEMO-HRSA Response to OMB- Intervention Trials ICR.doc Supplementary Document
Tabs 2 - 4.Phase 2 Skill Domains.doc Supplementary Document
Tab1c.Retention in Care Study-WAIT Rm Poster3-4-09.pdf Supplementary Document
Tab1c.Retention in Care Study-EXAM Rm Poster3-4-09.pdf Supplementary Document
Tab1b.pocketguide for clinic staff with agency logos 3-27-09.ppt Supplementary Document
Tab1b.pocketguide for clinicians with agency logos 3-27-09.ppt Supplementary Document
Tab1a.Brochure_03_04_09.pdf Supplementary Document
SS Part B-Retention Intervention Trials HIV.docSupporting Statement B
Tab 13 Informed Consent.doc Supplementary Document
Tab 12 IRB Approval.doc Supplementary Document
Tab 5 Eligibility Criteria.doc Supplementary Document
Revised SS Part A based on 11.17.09 OMB comments-ICR_RetentionHIVIntervention.docSupporting Statement A
Intervention Trials- Contact/Locator Information Form and Instruction
Intervention Trials- Retention Specialist/Patient Navigator Encounter Form Form and Instruction
Intervention Trials- Retention Risk Screener Form and Instruction
Intervention Trials- Patient Baseline Survey Form and Instruction
Intervention Trials- Patient Eligibility Screener Form
Intervention Trials- Patient Exit Survey Form and Instruction
Intervention Trials- Clinic Staff Survey Form and Instruction
Intervention Trials- Primary Care Provider Survey Form and Instruction
Intervention Trials- Electronic Clinic Data Abstraction Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
200908-0915-003 New collection (Request for a new OMB Control Number) 2009-08-25 Approved with change