OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of a Comprehensive HIV Clinic-based Intervention to Improve Patients' Health and Reduce Transmission Risk

ICR 201311-0920-005 · OMB 0920-1002 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Provider Survey (English Only) Form and Instruction New Repair queued
Patient Exit Survey (English, Spanish & Creole) Form and Instruction New Available
Computer-Based Intervention Assessment Items (English&Spanish) Form and Instruction New Available
Patient Behavior Screener (for English, Spanish & Creole) Form and Instruction New Available
Supporting Statement B.docx Supporting Statement B Uploaded 2013-10-31 Available
App 2 60-Day FRN Published.pdf Supplementary Document Uploaded 2013-10-31 Available
App 15 Project Determination.pdf Supplementary Document Uploaded 2013-10-31 Available
App 3 Clinical&Dem Variables.docx Supplementary Document Uploaded 2013-10-31 Available
App 13 IRB approvals from participating sites.docx Supplementary Document Uploaded 2013-10-31 Available
Supporting Statement A.docx Supporting Statement A Uploaded 2013-10-31 Available
IC Document Collections
IC IDCollectionTypeStatusForm
209259 Provider Survey (English Only) Form and Instruction New
209258 Patient Exit Survey (English, Spanish & Creole) Form and Instruction New
209257 Computer-Based Intervention Assessment Items (English&Spanish) Form and Instruction New
209256 Patient Behavior Screener (for English, Spanish & Creole) Form and Instruction New
209255 Electronic Transmittal of Clinical Variables Archived in Clinic Databases--Data Manager/no form Other-Records/Data extraction New
ICR Details
0920-1002 201311-0920-005
Historical Active
HHS/CDC 20821
Assessment of a Comprehensive HIV Clinic-based Intervention to Improve Patients' Health and Reduce Transmission Risk
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/13/2013
Retrieve Notice of Action (NOA) 11/08/2013
  Inventory as of this Action Requested Previously Approved
12/31/2016 36 Months From Approved
33,171 0 0
3,378 0 0
11,667 0 0
The purpose of this project is to increase the percentage of HIV patients who (1) have an undetectable viral load, (2) adhere optimally to antiretroviral therapy (ART), (3) attend clinic regularly for primary care, and (4) practice safer sex. These are objectives of the National HIV/AIDS Strategy and goals of the strategic plan of the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention. The project will be conducted at six HIV clinics in the United States with the following institutions: (1) Baylor College of Medicine, Houston, (2) Boston Medical Center, (3) University of Alabama, Birmingham, (4) University of California at San Diego, (5) University of Miami Medical School, and (6) University of Washington in the state of Washington. The intervention focuses primary on HIV patients who have a detectable viral load, i.e., their viral load is not as low as it can be and is not fully controlled. The intervention includes: (1) brief counseling from medical providers during primary care visits informed by a behavioral screener completed by patients; (2) a computer-based intervention (CBI) in which patients see short audio/visual about the importance of regular clinic attendance, adherence to ART, and safer sex; and (3) opportunity for one-on-one counseling from a prevention specialist if needed.
US Code: 3 USC 301 Name of Law: General Powers and Duties of Public Health Service: Research and Investigations
  
None
Not associated with rulemaking
  78 FR 9923 02/12/2013
78 FR 64942 10/30/2013
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 33,171 0 0 33,171 0 0
Annual Time Burden (Hours) 3,378 0 0 3,378 0 0
Annual Cost Burden (Dollars) 11,667 0 0 11,667 0 0
Yes
Miscellaneous Actions
No
This is a new Information Collection Request.
$1,980,609
Yes Part B of Supporting Statement
No
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.
11/08/2013