OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Web-based HIV Behavioral Survey among Men who have Sex with Men

ICR 201112-0920-011 · OMB 0920-0928 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Behavioral Assessment Form New Available
Eligibility Screener Form New Repair queued
Web-based project_Assurance Email.pdf Supplementary Document Uploaded 2012-03-13 Repair queued
Revised Campaign Message information.docx Supplementary Document Uploaded 2012-03-13 Repair queued
Web based survey_Part B.docx Supporting Statement B Uploaded 2011-12-15 Available
Affordable Care HR3590 Citation.docx Supplementary Document Uploaded 2011-12-19 Available
Att 7 Model Consent Form.docx Supplementary Document Uploaded 2011-12-15 Repair queued
Att 6 Assurance of confidentiality.pdf Supplementary Document Uploaded 2011-12-15 Available
Att 5b Public Comment_WHBS_final.docx Supplementary Document Uploaded 2011-12-15 Repair queued
Att 5a Public Comment.pdf Supplementary Document Uploaded 2011-12-15 Repair queued
Att 4 60 day Federal Register Notice.pdf Supplementary Document Uploaded 2011-12-15 Available
Att 1c 308d Public Health Service Act.docx Supplementary Document Uploaded 2011-12-15 Repair queued
Att 1b 306 Public Health Service Act.docx Supplementary Document Uploaded 2011-12-15 Available
Att 1a 301 Public Health Service Act.docx Supplementary Document Uploaded 2011-12-15 Available
Att 2c Screen Shots of Survey.pdf Supplementary Document Uploaded 2011-12-15 Available
Web based survey_Part A.docx Supporting Statement A Uploaded 2011-12-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200523 Behavioral Assessment Form New
200522 Eligibility Screener Form New
ICR Details
0920-0928 201112-0920-011
Historical Active
HHS/CDC
Web-based HIV Behavioral Survey among Men who have Sex with Men
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/30/2012
Retrieve Notice of Action (NOA) 12/19/2011
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved
479,090 0 0
44,819 0 0
0 0 0
CDC has received funding from the Affordable Care Act's Prevention and Public Health Fund to conduct an annual, national, web-based behavioral suvey to monitor HIV risk behavior and exposure to prevention services among internet-using MSM. Data will be collected in 56 jurisdictions and 21 MSAs with the highest AIDS prevalence in the US. The data will enhance CDC's ability to monitor national trends in HIV and direct HIV prevention programs and policies.
US Code: 42 USC 301,306 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  76 FR 125 06/29/2011
76 FR 78262 12/16/2011
Yes
  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 479,090 0 0 479,090 0 0
Annual Time Burden (Hours) 44,819 0 0 44,819 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR; it is ACA funded.
$1,055,487
Yes Part B of Supporting Statement
Yes
Yes
No
No
Uncollected
Daniel Holcomb 770 488-4472 [email protected]
  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.
12/19/2011