OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV)

ICR 200909-0920-010 · OMB 0920-0837 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
09AF_SS_SectB_090209.doc Supporting Statement B Uploaded 2009-09-03 Available
09AF_Att6a_CDC IRB Approval.pdf Supplementary Document Uploaded 2009-09-04 Available
09AF_Att2_60 Day FRN.pdf Supplementary Document Uploaded 2009-09-03 Available
09AF_Att1b_legislation Sect 308(d) .pdf Supplementary Document Uploaded 2009-09-03 Available
09AF_Att1a_legislation Sect301.pdf Supplementary Document Uploaded 2009-09-03 Available
09AF_Att4d_Syringe Customer Participant In-Pharmacy Testing Consent.doc Supplementary Document Uploaded 2009-09-04 Available
09AF_Att4c_Syringe Customer Participant Referral Consent.doc Supplementary Document Uploaded 2009-09-04 Available
09AF_Att4b_Pharmacy Staff Consent 0920-09XX.doc Supplementary Document Uploaded 2009-09-04 Repair queued
092009AF_att4a_Pharmacist Consent_121009.doc Supplementary Document Uploaded 2009-12-11 Available
0920-09AF_SS_SectA_121009.doc Supporting Statement A Uploaded 2009-12-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
190726 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV) - Pharmacy Telephone Screening and Enrollment Form Other-WORD New
190725 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Pharmlink Participant Baseline Survey (Syringe Customer) Other-WORD New
190724 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Pharmacy Staff Exit Surve (Pharmacists and Pharmacy Technicians) Other-WORD New
190723 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Syringe Transaction and Referral Log (Pharmacy Technicians) Other-WORD New
190722 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Pharmacy Staff Monthly Survey (Pharmacists) Other-WORD New
190721 Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV) - Pharmacy Monthly Survey (Pharmacists) Other-WORD New
190720 "Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV)" - Pharmacy Staff Baseline Survey (Pharmacist) Other-WORD New
ICR Details
0920-0837 200909-0920-010
Historical Active
HHS/CDC
Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/08/2010
Retrieve Notice of Action (NOA) 09/17/2009
Approval is provided for 18 months of data collection; a longer clearance period is given to provide a buffer for delays associated with recuiting.
  Inventory as of this Action Requested Previously Approved
01/31/2013 36 Months From Approved
4,141 0 0
496 0 0
0 0 0
This project involves two kinds of studies: testing service models at pharmacies and, interviewing individuals regarding the availability of syringes through pharmacies. For testing service models CDC will collaborate with the New York Academy of Medicine (NYAM) to implement this project for a period of three years. The NYAM will identify 12 ESAP pharmacies in East Harlem, New York City; ten of which will test a model that refers injection-drug-using syringe customers for HIV testing to local HIV testing sites. Two ESAP pharmacies will evaluate the feasibility of offering and performing HIV counseling and testing in the pharmacy for injection-drug-using syringe customers. Two types of respondents will provide the individual-level data; forty-eight adult (age >18 yrs) pharmacy staff members will be surveyed to learn about pharmacy staff attitudes and behaviors regarding HIV testing and referral. The other respondent group will be 442 adult (age >18 yrs) injection-drug-using syringe customers who will complete a brief quantitative interview after HIV referral or HIV testing is offered to them. HIV-seropositive injection-drug-using syringe customers identified during HIV testing will be immediately linked to social and medical services.
US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 308d Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  73 FR 69663 11/19/2008
74 FR 168 09/01/2009
No
  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 4,141 0 0 4,141 0 0
Annual Time Burden (Hours) 496 0 0 496 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
$346,797
Yes Part B of Supporting Statement
Yes
Uncollected
Uncollected
No
Uncollected
Thelma Sims 4046394771
  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.
09/17/2009