OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[NCHHSTP] Expanding PrEP in Communities of Color (EPICC)

OMB 0920-1423 ยท HHS/CDC.

OMB 0920-1423

The purpose of this study is to implement and evaluate the effectiveness of a clinic-based intervention that utilizes evidence-based education and support tools to 1) increase provider knowledge of and comfort with HIV preexposure prophylaxis (PrEP) modalities in clinical practice and 2) improve PrEP adherence among young men and non-binary persons who have sex with men (YMSM). This Change Request is submitted to make minor edits to a few instruments and supporting statements.

The latest form for [NCHHSTP] Expanding PrEP in Communities of Color (EPICC) expires 2026-12-31 and is listed under ICR 202601-0920-013.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Aims 1&2 Clinic Assessment (every 6 months)Form and Instruction
Aim 1&2 Clinic Assessment BaselineForm and Instruction
Aims 1&2 Clinic Assessment (Baseline & Final)Form and Instruction
Form 0920-1423 Att 4q_Aim2b Provider Focus Group Guide _REV 19SEP2025Form and Instruction
Form 0920-22GA Att 4o_Aim2b Provider FocusGroup Contact InformationForm and Instruction
Form 0920-1423 Att 4p_Aim2b Provider Pre-Focus Group Survey _REV 19SEP2025Form and Instruction
Form 0920-1423 Aim 2b Provider Pre-Focus Group Survey_23DEC2024Form and Instruction
Form 0920-22GA Att 4p_Aim2b Provider Pre FocusGroup SurveyForm and Instruction
Form 0920-22GA Att 4o_Aim2b Provider FocusGroup Contact InformationForm and Instruction
Form 0920-22GA Att_4n_Aim2bProvider FocusGroup ScreenerForm and Instruction
Form 0920-22GA Aim 2b Provider Focus Group ScreenerForm and Instruction
Form 0920-1423 Att 4m_Aim2a Cohort Exit Interview Spanish _REV 19SEP2025Form and Instruction
Form 0920-1423 Att 4m_Aim2a Cohort Exit Interview English _REV 19SEP2025Form and Instruction
Form 0920-22GA Att 4m_Aim2aCohortExitInterviewSpanishForm and Instruction
Form 0920-22GA Att 4m_Aim2a Cohort Exit Interview EnglishForm and Instruction
Form 0920-1423 Aim 2a Cohort Blood Collection Instructions_SpanishForm and Instruction
Form 0920-1423 Aim 2a Cohort Blood Collection Instructions_EnglishForm and Instruction
Form 0920-22GA Att 4l_Aim2a Cohort Blood Collection Instructions EnglishForm and Instruction
Form 0920-1423 Att 4j - Aim2a Cohort App Setup English-Spanish _REV 19SEP2025Form and Instruction
Form 0920-22GA Att 4j_Aim2aCohortAppSetupEnglishSpanishForm and Instruction
Form 0920-22GA Aim 2a Cohort App Setup (English/Spanish)Form and Instruction
Aim2a Cohort Follow-up Survey SpanishForm and Instruction
Aim2a Cohort Follow-up Survey EnglishForm and Instruction
Aim 2a Cohort Follow Up Survey (English/Spanish)Form and Instruction
Aim2a Cohort Baseline Survey SpanishForm and Instruction
Aim2a Cohort Baseline Survey EnglishForm and Instruction
Aim 2a Cohort Baseline Survey (English/Spanish)Form and Instruction
Form 0920-22GA Att 4h_Aim2aCohortHIPAAFormSpanishForm and Instruction
Form 0920-22GA Att 4h_Aim2aCohortHIPAAFormEnglishForm and Instruction
Form 0920-22GA Aim 2a Cohort HIPAA Form (English & Spanish)Form and Instruction
Form 0920-22GA Att 4b_Aim1ProviderTrainingContactInformationForm and Instruction
Form 0920-22GA Aim 2a Cohort Contact Information (English/Spanish)Form and Instruction
Form 0920-1423 Att 4f - Aim2a Cohort Screener Spanish_REV 19SEP2025Form and Instruction
Form 0920-1423 Att 4f - Aim2a Cohort Screener English_REV 19SEP2025Form and Instruction
Form 0920-1423 Aim 2a - Cohort Screeeer_SpanishForm and Instruction
Form 0920-1423 Aim 2a - Cohort Screeeer_EnglishForm and Instruction
Form V2023-1102 Elegibilidad de cohorte (Aim2aCohortScreener_Spanish)Form and Instruction
Form MOD00003217 Aim 2a Cohort Screener EnglishForm and Instruction
Form MOD00003217 Aim 2a Cohort Screener (English/Spanish)Form and Instruction
Form 0920-22GA Att 4e_Aim1ProviderPatientInteractionForm and Instruction
Form 0920-22GA Aim 1 Provider Patient Interaction (Baseline and Final)Form and Instruction
Form 0920-22GA Att 4d_Aim1ProviderPostTrainingSurveyForm and Instruction
Form 0920-22GA Aim 1 Provider Post-Training SurveyForm and Instruction
Form MOD00003217 Aim 1 Provider Pre-Training SurveyForm and Instruction
Form 0920-22GA Att 4b_Aim1ProviderTrainingContactInformationForm and Instruction
Form 0920-22GA Aim 1 Provider Training Contact InformationForm and Instruction
Form 0920-22GA Att 4a_Aim1ProviderTrainingScreenerForm and Instruction
EPICC Justification and Summary of Changes.docxJustification for No Material/Nonsubstantive Change
EPICC Justification and Summary of Changes.docx Justification for No Material/Nonsubstantive Change
Change Request Memo_EPICC.docxJustification for No Material/Nonsubstantive Change
Change Request Memo_EPICC.docx Justification for No Material/Nonsubstantive Change
Att 5b_Consent_Spanish_clean.docxSupplementary Document
Att 5b_Consent_English_clean.docxSupplementary Document
Att 5b_Consent_English_clean.docx Supplementary Document
Att 3b_RecruitmentPlan_Spanish_clean.docxSupplementary Document
Att 3b_RecruitmentPlan_English_clean.docxSupplementary Document
Att 3b_RecruitmentPlan_English_clean.docx Supplementary Document
Justification and Summary of Changes.docxJustification for No Material/Nonsubstantive Change
Justification for Nonmaterial Nonsubstantive Change to an OMB Approved Information Collection.docxJustification for No Material/Nonsubstantive Change
Justification for Nonmaterial Nonsubstantive Change to an OMB Approved Information Collection.docx Justification for No Material/Nonsubstantive Change
Att 10_Summary of Changes Table (24BY).docxSupplementary Document
Att 10_Summary of Changes Table (24BY).docx Supplementary Document
Att_6l_Wake_County_Health_Department_IRB_agreement[1].pdfSupplementary Document
Att_6l_Wake_County_Health_Department_IRB_agreement[1].pdf Supplementary Document
Att_6k_Baylor_Harris_Health_PrEP_Clinic_IRB_agreement[1].pdfSupplementary Document
Att_6k_Baylor_Harris_Health_PrEP_Clinic_IRB_agreement[1].pdf Supplementary Document
Att_6j_Bliss_Healthcare_Services_IRB_agreement[1].pdfSupplementary Document
Att_6j_Bliss_Healthcare_Services_IRB_agreement[1].pdf Supplementary Document
Att_6i_USF_Ybor_Youth_Clinic_IRB_agreement[1].pdfSupplementary Document
Att_6i_USF_Ybor_Youth_Clinic_IRB_agreement[1].pdf Supplementary Document
Att_6h_Five_Horizons_Health_Services_IRB_agreement[1].pdfSupplementary Document
Att_6h_Five_Horizons_Health_Services_IRB_agreement[1].pdf Supplementary Document
Att_6g_Amity_Medical_Group_IRB_agreement[1].pdfSupplementary Document
Att_6g_Amity_Medical_Group_IRB_agreement[1].pdf Supplementary Document
Att_6f_Childrens_Hospital_of_Philadelphia_IRB_agreement[1].pdfSupplementary Document
Att_6f_Childrens_Hospital_of_Philadelphia_IRB_agreement[1].pdf Supplementary Document
Att_6e_Childrens_Hospital_Montefiore_IRB_agreement[1].pdfSupplementary Document
Att_6e_Childrens_Hospital_Montefiore_IRB_agreement[1].pdf Supplementary Document
Att_6d_Cook_County_HHS_IRB_agreement[1].pdfSupplementary Document
Att_6d_Cook_County_HHS_IRB_agreement[1].pdf Supplementary Document
Att_6b_University_of_North_Carolina_Chapel_Hill_IRB_agreement[1].pdfSupplementary Document
Att_6b_University_of_North_Carolina_Chapel_Hill_IRB_agreement[1].pdf Supplementary Document
Att_6a_Florida_State_University_IRB_Letter_of_Approval[1].pdfSupplementary Document
Att_6a_Florida_State_University_IRB_Letter_of_Approval[1].pdf Supplementary Document
Att_9_Provider_Training_Summary[1].docxSupplementary Document
Att_9_Provider_Training_Summary[1].docx Supplementary Document
Att_7_Data_Use_Plan_EPICC[1].docxSupplementary Document
Att_7_Data_Use_Plan_EPICC[1].docx Supplementary Document
Att_1_Auth_Legislation[1].docxSupplementary Document
30_Day_FRN_EPICC[1].docxSupplementary Document
SSB_Clean_12.22.25.docxSupporting Statement B
SSB_Clean_12.22.25.docxSupporting Statement B
SSA_Clean_12.22.25.docxSupporting Statement A
SSA_Clean_12.22.25.docxSupporting Statement A
Aims 1&2 Clinic Assessment (every 6 months) Form and Instruction
Aims 1&2 Clinic Assessment (every 6 months) Form and Instruction
Aims 1&2 Clinic Assessment (Baseline & Final) Form and Instruction
Aims 1&2 Clinic Assessment (Baseline & Final) Form and Instruction
Aim 2b Provider Focus Group Guide Form and Instruction
Aim 2b Provider Focus Group Guide Form and Instruction
Aim 2b Provider Focus Group Guide Form and Instruction
Aim 2b Provider Pre-Focus Group Survey Form and Instruction
Aim 2b Provider Pre-Focus Group Survey Form and Instruction
Aim 2b Provider Pre-Focus Group Survey Form and Instruction
Aim 2b Provider Pre-Focus Group Survey Form and Instruction
Aim 2b Provider Focus Group Contact Information Form and Instruction
Aim 2b Provider Focus Group Contact Information Form and Instruction
Aim 2b Provider Focus Group Screener Form and Instruction
Aim 2b Provider Focus Group Screener Form and Instruction
Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Aim 2a Cohort Exit Interview (English/Spanish) Form and Instruction
Aim 2a Cohort Blood Collection Instructions (English/Spanish) Form and Instruction
Aim 2a Cohort Blood Collection Instructions (English/Spanish) Form and Instruction
Aim 2a Cohort Blood Collection Instructions (English/Spanish) Form and Instruction
Aim 2a Cohort Blood Collection Instructions (English/Spanish) Form and Instruction
Aim 2a Cohort App Setup (English/Spanish) Form and Instruction
Aim 2a Cohort App Setup (English/Spanish) Form and Instruction
Aim 2a Cohort App Setup (English/Spanish) Form and Instruction
Aim 2a Cohort Follow Up Survey (English/Spanish) Form and Instruction
Aim 2a Cohort Follow Up Survey (English/Spanish) Form and Instruction
Aim 2a Cohort Follow Up Survey (English/Spanish) Form and Instruction
Aim 2a Cohort Baseline Survey (English/Spanish) Form and Instruction
Aim 2a Cohort Baseline Survey (English/Spanish) Form and Instruction
Aim 2a Cohort Baseline Survey (English/Spanish) Form and Instruction
Aim 2a Cohort HIPAA Form (English & Spanish) Form and Instruction
Aim 2a Cohort HIPAA Form (English & Spanish) Form and Instruction
Aim 2a Cohort HIPAA Form (English & Spanish) Form and Instruction
Aim 2a Cohort Contact Information (English/Spanish) Form and Instruction
Aim 2a Cohort Contact Information (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 2a Cohort Screener (English/Spanish) Form and Instruction
Aim 1 Provider Patient Interaction (Baseline and Final) Form and Instruction
Aim 1 Provider Patient Interaction (Baseline and Final) Form and Instruction
Aim 1 Provider Post-Training Survey Form and Instruction
Aim 1 Provider Post-Training Survey Form and Instruction
Aim 1 Provider Pre- Training Survey Form and Instruction
Aim 1 Provider Pre- Training Survey Form and Instruction
Aim 1 Provider Training Contact Information Form and Instruction
Aim 1 Provider Training Contact Information Form and Instruction
Aim 1 Provider Training Screener Form and Instruction
Aim 1 Provider Training Screener Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202601-0920-013 No material or nonsubstantive change to a currently approved collection 2026-01-30 Approved without change
202509-0920-006 No material or nonsubstantive change to a currently approved collection 2025-09-22 Approved without change
202412-0920-015 No material or nonsubstantive change to a currently approved collection 2024-12-23
202401-0920-004 No material or nonsubstantive change to a currently approved collection 2024-01-08 Approved without change
202309-0920-011 New collection (Request for a new OMB Control Number) 2023-10-31 Approved without change

OMB Details

Aim 1 Provider Training Screener

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Information collection instruments
FormNameElectronic accessType
Form 0920-22GAAtt 4a_Aim1ProviderTrainingScreenerFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.