OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services

ICR 201104-0920-002 · OMB 0920-0775 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Partner Services Paper and Pencil Questionnaire Form Modified Available
Prevention Is Care (PIC) Paper and Pencil Questionnaire Form Modified Available
Emergency Departments Paper and Pencil Questionnaire Form Modified Available
Prevention Is Care (PIC) Study Screener Form Modified Available
Partner Services Study Screener Form Modified Repair queued
Emergency Departments Study Screener Form Modified Available
HIV Partner Services Material Testing Interview Form Modified Available
HIV Partner Services Concept Testing Interview Form Modified Available
Prevention Is Care (PIC) Material Testing Interview Form Modified Available
Emergency Departments Material Testing Interview Form Modified Available
15 Section B - Statistical Methods 03-16-11.docx Supporting Statement B Uploaded 2011-03-23 Available
A8_Recruitment Agreement 2-24-11.doc Supplementary Document Uploaded 2011-03-23 Available
0775 60-day Pub12-3-2010.pdf Supplementary Document Uploaded 2011-03-23 Available
Attach1 Authorizing Legislation-Provider Extension.docx Supplementary Document Uploaded 2011-03-23 Repair queued
A5c_Consent Forms-PS_3-1-11.doc Supplementary Document Uploaded 2011-03-23 Available
A5c_Consent Forms-PS_3-1-11.doc Supplementary Document Uploaded 2011-03-23 Available
A5b_Consent Forms-PIC_3-1-11.doc Supplementary Document Uploaded 2011-03-23 Available
A5a_Consent Forms-RT_3-1-11.doc Supplementary Document Uploaded 2011-03-23 Available
14 Section A - Justification_Extension Request 03-02-01.docx Supporting Statement A Uploaded 2011-03-23 Available
IC Document Collections
IC IDCollectionTypeStatusForm
183191 Partner Services Paper and Pencil Questionnaire Form Modified
183190 Prevention Is Care (PIC) Paper and Pencil Questionnaire Form Modified
183189 Emergency Departments Paper and Pencil Questionnaire Form Modified
183188 Prevention Is Care (PIC) Study Screener Form Modified
183187 Partner Services Study Screener Form Modified
183186 Emergency Departments Study Screener Form Modified
183185 HIV Partner Services Material Testing Interview Form Modified
183184 HIV Partner Services Concept Testing Interview Form Modified
183183 HIV Partner Services Exploratory Research Other-WORD Removed
183182 Prevention Is Care (PIC) Material Testing Interview Form Modified
183181 Emergency Departments Material Testing Interview Form Modified
ICR Details
0920-0775 201104-0920-002
Historical Active 200712-0920-011
HHS/CDC
Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services
Extension without change of a currently approved collection   No
Regular
Approved without change 05/10/2011
Retrieve Notice of Action (NOA) 04/08/2011
  Inventory as of this Action Requested Previously Approved
05/31/2014 36 Months From Approved 05/31/2011
293 0 476
117 0 194
0 0 0
This project involves formative research to inform the development of 3 CDC-sponsored social marketing campaigns: 1) Social Marketing Campaigns to Make HIV Testing a Routine Part of Medical Care for Emergency Medicine Physicians (Routine HIV Testing); 2) Prevention Is Care (PIC); and 3) Partner Services (Partner Services). Activities include conducting interviews to test creative materials with groups of emergency medicine physicians for Routine HIV Testing and, PCP and Infectious Disease Specialists for PIC and Partner Services.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  75 FR 75474 12/03/2010
76 FR 16629 03/24/2011
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 293 476 0 -183 0 0
Annual Time Burden (Hours) 117 194 0 -77 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The program requests an extension to complete the 82 remaining interviews for this project; all exploratory research has been completed.
$293,652
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Walker 4046394773
  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.
04/08/2011