OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

HIV Prevention among Latino MSM: Evaluation of a locally developed intervention

ICR 201202-0920-004 · OMB 0920-0942 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Rev Supporting Statement B-HIV Prevention among Latino MSM.docx Supporting Statement B Uploaded 2012-06-12 Available
Attachments 6a-6b - Two Versions of Study Ads.docx Supplementary Document Uploaded 2012-06-12 Repair queued
Attachment 11 - CAB membership list.docx Supplementary Document Uploaded 2012-02-08 Available
Attachment 10 - All-PI meeting participant list.docx Supplementary Document Uploaded 2012-02-08 Repair queued
Attachment 9 - NCHHSTP project determination.pdf Supplementary Document Uploaded 2012-02-08 Available
Attachment 8 - Local IRB approvals.pdf Supplementary Document Uploaded 2012-02-08 Available
Attachment 1 - Public Health Service Act.docx Supplementary Document Uploaded 2012-02-08 Available
Attachment 7 - Consent forms.pdf Supplementary Document Uploaded 2012-02-08 Repair queued
Supporting Statement A-HIV Prevention among Latino MSM.docx Supporting Statement A Uploaded 2012-06-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
201268 6-Month Follow-up Assessment Other-Attachment 5 - Six-Month Follow-Up Assessment New
201267 Baseline Assessment Questionnaire Other-Attachment 4 Baseline Assessment questionnaire New
201266 Participant Screening Form Other-Attachment 3 New
ICR Details
0920-0942 201202-0920-004
Historical Active
HHS/CDC
HIV Prevention among Latino MSM: Evaluation of a locally developed intervention
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/28/2012
Retrieve Notice of Action (NOA) 02/15/2012
  Inventory as of this Action Requested Previously Approved
06/30/2015 36 Months From Approved
950 0 0
883 0 0
0 0 0
This study will use a randomized controlled trial design to collect data needed to assess the efficacy of the Spanish-language, small-group HOLA en Grupos intervention compared to a general health comparison intervention.
None
None
Not associated with rulemaking
  76 FR 206 10/25/2011
77 FR 6802 02/09/2012
No
3
IC Title Form No. Form Name
Participant Screening Form
Baseline Assessment Questionnaire
6-Month Follow-up Assessment
  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 950 0 0 950 0 0
Annual Time Burden (Hours) 883 0 0 883 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a New ICR
$653,943
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Catina Conner 4046394775
  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.
02/15/2012