Information Collection

Evaluating Social Marketing Campaigns Targeting Gay/Bisexual Men

IC 213907 under ICR 201403-0920-004 · OMB 0920-0920.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0920 can be found here:

Documents and Forms

Document Name Document Type
att1_surveyscreenshots.pdf Other-PDF
att2_screenerscreenshots.pdf Other-PDF
Att 3_Consent Form.docx Att 3 Consent Form IC Document
Att 4_Email Reminder.docx Att 4_Email Reminder IC Document
Supporting Statement A.docx Supporting Statement A IC Document
Supporting Statement B_9-23-14 Clean.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluating Social Marketing Campaigns Targeting Gay/Bisexual Men	Agency IC Tracking Number:	14AYF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PDF			att1_surveyscreenshots.pdf		Yes	Yes	Fillable Printable
Other-PDF			att2_screenerscreenshots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3 Consent Form	Att 3_Consent Form.docx	11/14/2014
Att 4_Email Reminder	Att 4_Email Reminder.docx	11/14/2014
Supporting Statement A	Supporting Statement A.docx	11/14/2014
Supporting Statement B	Supporting Statement B_9-23-14 Clean.docx	11/14/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.