Information Collection Request

Critical Thinking and Cultural Affirmation: Evaluation of a Locally Developed HIV Prevention Intervention

ICR 201205-0920-010 · OMB 0920-0945 · Historical Active

Forms and Documents

Document	Type	Status	Availability
Exit Interview	Form	New	Available
Exit Survey	Form	New	Repair queued
Form Attachment 10 6-month Assessment	Form	New	Available
Form Attachment 9 3-month Assessment	Form	New	Available
Participant Evaluation	Form	New	Available
Record Locator Form	Form	New	Available
Form Attachment 6 Baseline Assessment	Form	New	Available
Brief Locator Information	Form	New	Available
Full-screening	Form	New	Available
Pre-screening	Form	New	Available
Attachment 20 References for Raffle Studies.docx	Supplementary Document	Uploaded 2012-07-25	Available
Attachment 19 Example Health Messages.docx	Supplementary Document	Uploaded 2012-07-25	Available
Supporting Statement B_Comments July 19 2012_clean.docx	Supporting Statement B	Uploaded 2012-07-25	Available
CoC Dr. Wheeler Critical Thinkingand Cultural Affirmation Document (2).pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 17 Recruitment Flyer.docx	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 16 Final PD Approval with signature.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 15 IRB Approval - January 20 2012.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 13 Informed Consent-RCT.docx	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 1 Public Health Service Act.docx	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 2 60 day FRN 3.26.docx	Supplementary Document	Uploaded 2012-05-17	Available
Attachment 14-Informed Consent for Exit Interview.docx	Supplementary Document	Uploaded 2012-05-17	Available
Supporting Statement A_revised 7.26.12.docx	Supporting Statement A	Uploaded 2012-08-01	Available

IC Document Collections

IC ID	Collection	Type	Status
202463	Exit Interview	Form	New
202462	Exit Survey	Form	New
202461	6-month Assessment	Form	New
202460	3-month Assessment	Form	New
202459	Participant Evaluation	Form	New
202458	Record Locator Form	Form	New
202457	Baseline Assessment	Form	New
202456	Brief Locator Information	Form	New
202455	Full-screening	Form	New
202454	Pre-screening	Form	New

ICR Details

OMB Control No: 0920-0945	ICR Reference No: 201205-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Critical Thinking and Cultural Affirmation: Evaluation of a Locally Developed HIV Prevention Intervention
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/01/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/24/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved
Responses	2,221	0	0
Time Burden (Hours)	588	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The study will test the efficacy of the Critical Thinking and Cultural Affirmation (CTCA) HIV risk behavior intervention in reducing HIV risk behaviors among a sample of AAMSM in Chicago. It aims to further explicate and develop the CTCA intervention, to evaluate efficacy and cost-effectiveness in reducing AAMSM HIV risk behaviors, and to expand the body of research on HIV prevention/risk reduction practices for AAMSM. The study uses a randomized-controlled trial design to compare receiving the intervention to receiving basic men's health and wellness messaging.

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12057	02/28/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 29350	05/17/2012
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Pre-screening	none	Pre-screening
Full-screening	none	Full-screening
Brief Locator Information	none	Brief Locator Information
Baseline Assessment	Attachment 6	Baseline Assessment
Record Locator Form	none	Record Locator Form
Participant Evaluation	none	Participant Evaluation
3-month Assessment	Attachment 9	3 month follow-up
6-month Assessment	Attachment 10	6-Month Assessment
Exit Survey	none	Exit Survey
Exit Interview	none	Exit Interview

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	2,221	2,221
Annual Time Burden (Hours)	588	588
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

Annual Cost to Federal Government: $664,983

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Tony Richardson 404 639-4965 [email protected]

Common Form ICR: No