OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation Models to Assess Patient Perspectives on Opt-out HIV Testing in Clinical Settings

ICR 200903-0920-004 · OMB 0920-0810 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Patient Survey Form New Available
Final Supporting Statement B .doc Supporting Statement B Uploaded 2009-02-19 Available
0920-08BFAtt 8 References.doc Supplementary Document Uploaded 2009-02-12 Available
0920-08BFAtt 7 Model Consent.doc Supplementary Document Uploaded 2009-02-12 Available
0920-08BFAtt 6 Assurance of Confidentiality.doc Supplementary Document Uploaded 2009-02-12 Repair queued
0920-08BFAtt 5 Non Research Determination.doc Supplementary Document Uploaded 2009-02-12 Repair queued
0920-08BFAtt 4 Consultants.doc Supplementary Document Uploaded 2009-02-12 Available
0920-08BFAtt 2b Comment to FRN.doc Supplementary Document Uploaded 2009-02-12 Available
0920-08BFAtt 1 PHSA.pdf Supplementary Document Uploaded 2009-02-12 Available
0920-08BFAtt 2a Initial 60 Day FRN.pdf Supplementary Document Uploaded 2009-02-12 Available
Final Supporting Statement A .doc Supporting Statement A Uploaded 2009-02-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188353 Patient Survey Form New
ICR Details
0920-0810 200903-0920-004
Historical Active
HHS/CDC
Evaluation Models to Assess Patient Perspectives on Opt-out HIV Testing in Clinical Settings
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/29/2009
Retrieve Notice of Action (NOA) 03/10/2009
Approved consistent with the understanding that the final package - with any changes based on this pilot - will be submitted to OMB for review and approval prior to including in a national tookit and implementing in all AETCs.
  Inventory as of this Action Requested Previously Approved
05/31/2010 12 Months From Approved
450 0 0
150 0 0
0 0 0
This project is to support the development and dissemination of administrative tools and other educational and training materials needed to implement the revised guidelines through a model evaluation toolkit for providers to assess attitudes, reactions, and acceptance of HIV screening by patients.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  73 FR 33823 06/13/2008
74 FR 7066 02/12/2009
Yes
1
IC Title Form No. Form Name
Patient Survey None Patient Survey
  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 450 0 0 450 0 0
Annual Time Burden (Hours) 150 0 0 150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$533,507
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Maryam Daneshvar 4046394604
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/10/2009