OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)

ICR 201108-0920-002 · OMB 0920-0896 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 7 180-day Follow-up Form and Instruction New Available
Form 6 90-day Follow-up Interview Form and Instruction New Available
Form 3 Baseline Survey Form and Instruction New Available
Form 1 Eligibility Screener Form and Instruction New Available
0920-New_SS-Part B.doc Supporting Statement B Uploaded 2011-08-08 Available
0920-New_att4_Participation Agreement.pdf Supplementary Document Uploaded 2011-08-08 Repair queued
0920-New_SS-Part A_080411_WILLOW-Revised 8.5.11.DOC Supporting Statement A Uploaded 2011-08-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
198815 180-day Follow-up Interview--Grantee Other-Screen Shot New
198814 180-day Follow-up Form and Instruction New
198813 90-day Follow-up Interview--Grantees Other-screen shot New
198812 90-day Follow-up Interview Form and Instruction New
198811 Baseline Survey--Grantees Other-Screen shot New
198810 Baseline Survey Form and Instruction New
198809 Eligibility Screener--Grantees Other-screen shot New
198808 Eligibility Screener Form and Instruction New
ICR Details
0920-0896 201108-0920-002
Historical Active
HHS/CDC
Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/12/2011
Retrieve Notice of Action (NOA) 08/09/2011
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved
1,732 0 0
358 0 0
0 0 0
The Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW has two purposes: 1) to monitor changes in client's self-reported HIV risk behaviors and attitudes after participating in the Effective Behavioral Intervention (EBI) WILLOW as delivered by CDC-funded CBOs and 2) to assess the fidelity of the delivery of WILLOW at CBOs. From July 2010 through July 2015, CMEP will provide additional funds through FOA 10-1003 to four CBOs to collect outcome monitoring data from 400 women who are living with HIV and participating in WILLOW as well as process and fidelity assessment data about the implementation of the interventions. CMEP-WILLOW will employ a repeated measures design to collect client-level data before the intervention and then again at three-months and six-months following the intervention. Findings will help to further understanding of how these interventions are delivered once they leave the research arena and whether or not they are associated with behavior change. Ultimately this information will help CBOs improve their intervention delivery and better serve clients.
PL: Pub.L. 111 - 241 301 Name of Law: Research and Investigations Generally
  
None
Not associated with rulemaking
  76 FR 6139 02/03/2011
76 FR 18553 04/04/2011
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 1,732 0 0 1,732 0 0
Annual Time Burden (Hours) 358 0 0 358 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$753,475
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Petunia Gissendaner 4046390164
  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.
08/09/2011