OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA

ICR 201008-0920-009 · OMB 0920-0872 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form no number A-CASI 3-Month Follow-up Form New Repair queued
Form no number Interview Baseline Form New Repair queued
Form no number A-CASI Baseline Form New Available
Form No number Screening Questionnaire Form New Repair queued
Attachment 5a_Recruitment Card and Script 11012010.docx Supplementary Document Uploaded 2010-11-02 Available
Attachment 4a_Participant Consent Form 11012010.docx Supplementary Document Uploaded 2010-11-02 Available
Attachment 3b_Quantitative Survey Measures11012010.docx Supplementary Document Uploaded 2010-11-02 Available
Attachment 3d_3 mth Follow-up Qualitative Interview Guide 11012010.docx Supplementary Document Uploaded 2010-11-02 Available
Attachment 3a_Screening Questionnaires 11012010.docx Supplementary Document Uploaded 2010-11-02 Available
SS_Part B.06162010.docx Supporting Statement B Uploaded 2010-07-27 Repair queued
Attachment 6a_local IRB 2011.pdf Supplementary Document Uploaded 2010-07-27 Available
Attachment 5d_Contact Tracking Log.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 5c_Participant Contact Template.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 5b_Locator Form.06162010.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 5a_Recruitment Card and Script.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 4b_Audio Recording Consent.07092010.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 4a_Participant Consent Form.07092010.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 2 Published 60 day2010-9606.pdf Supplementary Document Uploaded 2010-07-27 Available
Attachment 1_Legislative Authority.06162010.docx Supplementary Document Uploaded 2010-07-27 Available
Attachment 7b_NYS HIV Testing Flowchart.pdf Supplementary Document Uploaded 2010-08-03 Available
SS Part A 07092010.docx Supporting Statement A Uploaded 2010-07-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
194319 Interview 3-Month Follow-up Other-Interview Guidelines New
194318 A-CASI 3-Month Follow-up Form New
194317 HIV Testing and Counseling Baseline & 3-Month Follow-up Other-Cover Page New
194316 Interview Baseline Form New
194315 A-CASI Baseline Form New
194314 Screening Questionnaire Form New
ICR Details
0920-0872 201008-0920-009
Historical Active
HHS/CDC
Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/29/2010
Retrieve Notice of Action (NOA) 08/19/2010
  Inventory as of this Action Requested Previously Approved
11/30/2012 24 Months From Approved
2,350 0 0
1,338 0 0
0 0 0
The Centers for Disease Control and Prevention request approval to assess how interpersonal communication within Black men who have sex with men (BMSM) social networks may be related to risk for HIV Infection and attitudes towards HIV testing. This study will provide important epidemiologic information, useful for the development of HIV prevention interventions for BMSM.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  75 FR 21630 04/26/2010
75 FR 43988 07/27/2010
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 2,350 0 0 2,350 0 0
Annual Time Burden (Hours) 1,338 0 0 1,338 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
$366,000
Yes Part B of Supporting Statement
No
No
No
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.
08/19/2010