OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Understanding Barriers and Facilitators to HIV Prevention for Men who Have Sex with Men (MSM) - Pulse Study

ICR 201511-0920-012 · OMB 0920-1111 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-15AGK HIV-negative In-Depth Interview Guide Minors-Spanish Form and Instruction New Available
Form 0920-15AGK HIV-negative In-Depth Interview Guide General Public Adults -Spanish Form and Instruction New Available
Form 0920-15AGK Att 3e HIV-Neg MSM In-depth Int_English Form and Instruction New Available
Form 0920-15AGK HIV-negative MSM In-Depth Interview Guide Adults -English Form and Instruction New Repair queued
Form 0920-15AGK HIV-negative MSM Contact Information Form-Spanish Form and Instruction New Available
Form 0920-15AGK HIV-negative MSM Contact Information Form-English Form and Instruction New Available
Form 0920-15AGK HIV-negative MSM Screener-Spanish Form and Instruction New Available
Form 0920-015AGK HIV-negative MSM Screener-English Form and Instruction New Available
Task 6.2 Study Protocol v4.0.docx Supplementary Document Uploaded 2015-11-25 Available
Pulse ProjDeterm.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 9 Certificate of Confidentiality.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 8 Data Security Plan.docx Supplementary Document Uploaded 2015-11-25 Available
Att 7 Spanish Translation Cert.pdf Supplementary Document Uploaded 2015-11-25 Repair queued
Att 5e Emory University IRB Approval Amendment 6.18.15.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 5d Emory University IRB Approval Amendment 4.24.15.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 5c Emory RSS IAA Agreement 77517.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 5b Emory Univ IRB Amendment 1.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 5a Emory Univ IRB Approval Letter.pdf Supplementary Document Uploaded 2015-11-25 Available
Att 4d HIV-Neg MSM Assent Form_Spanish.docx Supplementary Document Uploaded 2015-11-25 Available
Att 4c HIV-Neg MSM Assent Form_English.docx Supplementary Document Uploaded 2015-11-25 Available
Att 4b HIV-Neg MSM Consent Form_Spanish.docx Supplementary Document Uploaded 2015-11-25 Repair queued
Att 4a HIV-Neg MSM Consent Form_English.docx Supplementary Document Uploaded 2015-11-25 Available
Supporting Statement B.docx Supporting Statement B Uploaded 2015-11-25 Available
SSA Clean_MSM Pulse Study.docx Supporting Statement A Uploaded 2016-04-01 Available
IC Document Collections
IC IDCollectionTypeStatusForm
219093 HIV-negative In-Depth Interview Guide Minors-Spanish Form and Instruction New
219092 HIV-negative In-Depth Interview Guide General Public Adults -Spanish Form and Instruction New
219091 Att 3e HIV-Neg MSM In-depth Int_English Form and Instruction New
219090 HIV-negative MSM In-Depth Interview Guide Adults -English Form and Instruction New
219089 HIV-negative MSM Contact Information Form-Spanish Form and Instruction New
219088 HIV-negative MSM Contact Information Form-English Form and Instruction New
219087 HIV-negative MSM Screener-Spanish Form and Instruction New
219086 HIV-negative MSM Screener-English Form and Instruction New
219085 State and Health Dept. CBO Recruitment Flyer- English and Spanish Instruction New
ICR Details
0920-1111 201511-0920-012
Historical Active
HHS/CDC 15AGK
Understanding Barriers and Facilitators to HIV Prevention for Men who Have Sex with Men (MSM) - Pulse Study
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 04/06/2016
Retrieve Notice of Action (NOA) 11/30/2015
Approved consistent with the understanding that this collection entails a qualitative study that will not be comparing outcomes between groups/cities or generalizing information to broader populations in the United States.
  Inventory as of this Action Requested Previously Approved
04/30/2017 36 Months From Approved
900 0 0
184 0 0
0 0 0
This study seeks to provide understanding on the many factors that prevent some men who have sex with men (MSM) and young MSM (YMSM) from contracting HIV. We will qualitatively examine how socio-geo-demographic factors such as HIV risk perception, perceptions of community relationships and social support serve as contributors and inhibitors to remaining HIV negative.
Statute at Large: 301 Stat. 241 Name of Statute: General Powers and Duties of Public Health Service
  
None
Not associated with rulemaking
  80 FR 27316 05/13/2015
80 FR 72436 11/19/2015
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 900 0 0 900 0 0
Annual Time Burden (Hours) 184 0 0 184 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
New ICR, no changes
$548,166
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 404 639-4775
  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.
11/30/2015