OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

HIV/AIDS Risk Reduction Interventions for African-American Heterosexual Men

ICR 201008-0920-012 · OMB 0920-0873 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
0920-10CM_Att5c6_Reminder Letter UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Repair queued
0920-10CM_Att5c4_Invitation to Email Screening UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att5c3_Recruitment Script UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att5c1_Invitation Intervention UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att4c_Consent Forms UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att4b_Consent Forms 8NYBC 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Repair queued
0920-10CM_Att4a_Consent Forms SUNY 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att3i_BL and FU Assessments UNCG 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att3h_BL and Assessments NYBC 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Repair queued
0920-10CM_Att3g_BL and Assessments SUNY 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_Att3b_Screening Form NYBC 11[1].15.2010-clean.docx Supplementary Document Uploaded 2010-11-22 Available
0920-10CM_SupSta_B 11[1].15.2010-clean.docx Supporting Statement B Uploaded 2010-11-22 Available
0920-10CM_Att8c_Local IRB Approval (UNCG).pdf Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att8b_Local IRB Approval (NYBC).pdf Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att8a_Local IRB Approval (SUNY).pdf Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att7c_Consultants (UNCG).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att7b_Consultants (NYBC).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att7a_Consultants (SUNY).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att6-References.doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att2_60-dayFRN.doc Supplementary Document Uploaded 2010-07-23 Available
0920-10CM_Att1_AuthorizingLegislation.doc Supplementary Document Uploaded 2010-07-23 Available
0920-10CM_Att5c6_Reminder Letter (UNCG).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att5c5_Reminder Scripts (UNCG).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att5c4_Invitation to Email Screening (UNCG).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att5c3_Recruitment Script (UNCG).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att5c2_Recruitment Flyer (UNCG).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att5c1_Invitation to Intervention (UNCG).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att4c_Consent Forms (UNCG).doc Supplementary Document Uploaded 2010-07-26 Available
0920-10CM_Att5b4_Reminder Letters (NYBC).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att5b3_Telephone Scripts (NYBC).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att5b1_Recruitment Card Flyer (NYBC).doc Supplementary Document Uploaded 2010-07-29 Repair queued
0920-10CM_Att5b2_Script for Recruitment (NYBC).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att4b_Consent Forms (NYBC).doc Supplementary Document Uploaded 2010-07-26 Repair queued
0920-10CM_Att5a3_Reminder Call Script (SUNY).doc Supplementary Document Uploaded 2010-07-26 Repair queued
0920-10CM_Att5a2_Contact and Appointment Card (SUNY).doc Supplementary Document Uploaded 2010-07-29 Available
0920-10CM_Att5a1_Recruitment Script (SUNY).doc Supplementary Document Uploaded 2010-07-26 Repair queued
0920-10CM_Att4a_Consent Forms (SUNY).doc Supplementary Document Uploaded 2010-07-26 Repair queued
0920-10CM_SupSta_A 11[1].15.2010-clean.docx Supporting Statement A Uploaded 2010-11-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
194338 Follow-up Assessment -- UNCG Other-WORD New
194337 Follow-up Assessment -- UNCG Other-WORD New
194336 Follow-up Assessment -- NYBC Other-WORD New
194335 Baseline Assessment -- NYBC Other-WORD New
194334 Follow-up Assessment -- SUNY Other-WORD New
194333 Baseline Assessment (SUNY) Other-WORD New
194332 Locator Form (UNCG) Other-WORD New
194331 Locator Form (NYBC) Other-WORD New
194330 Locator Form (SUNY) Other-WORD New
194329 Screening Form (UNCG) Other-WORD New
194328 Screening Form (NYBC) Other-WORD New
194327 Screening Form (SUNY) Other-WORD New
ICR Details
0920-0873 201008-0920-012
Historical Active
HHS/CDC
HIV/AIDS Risk Reduction Interventions for African-American Heterosexual Men
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
1,334 0 0
335 0 0
0 0 0
The Centers for Disease Control and Prevention requests approval for a new data collection entitled, "HIV/AIDS Risk Reduction Interventions for African-American Heterosexual Men," for two years. The purpose of this information collection is to pilot test three behavioral interventions targeting heterosexually active African American men. A limited number of HIV prevention intervention with demonstrated efficacy in reduction HIV related sexual risk behaviors have been developed and evaluated specifically for heterosexually active African American men who do not inject drugs, and who are at risk primarily due to unprotected sex with multiples or concurrent female sex partners. This project seeks to assess feasibility and acceptability of three risk reduction interventions and to collect preliminary data on the efficacy of the interventions to reduce HIV risk behaviors among the targeted population. The study design is a pilot intervention with a pre-test and post-test evaluation at three months. The project will be conducted by three sites: a) State University of New York Downstate-"SUNY" (Brooklyn, NY); (b) New York Blood Center-'NYBC'(Bronx & Harlem, NY); and (c) University of North Carolina-Greensboro-'UNCG' (Greensboro, NC). The data collection system for each site includes Screener Forms (Attachment 3a-3c), Locator Forms (Attachment 3d-3f), and Baseline and Follow-up Assessments (Attachments 3g-3i).
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  75 FR 20600 04/20/2010
75 FR 43987 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 1,334 0 0 1,334 0 0
Annual Time Burden (Hours) 335 0 0 335 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.
$828,500
Yes Part B of Supporting Statement
No
No
No
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.
08/19/2010