OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Community-based Organization Outcome Monitoring Projects for CBO HIV Prevention Services Clients

ICR 201608-0920-016 · OMB 0920-1172 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Focus Group Questionnaire Category 2 Form New Available
Focus Group Eligibility Screener Category 2 Form New Available
Follow-up Interviews Category 2 Form New Repair queued
Baseline Interview Category 2 Form New Repair queued
Interview Eligibility Screener Category 2 Form New Available
Focus Group Questionnaire Category 1 Form New Available
Focus Group Eligibility Screener Category 1 Form and Instruction New Available
Follow-up Interviews Category 1 Form New Available
Baseline Interview Category 1 Form New Available
Interview Eligibility Screener Category 1 Form New Available
Att4f Staff Int Consent Cat 2.docx Supplementary Document Uploaded 2016-08-29 Available
Att4e Staff Int Consent Cat 1.docx Supplementary Document Uploaded 2016-08-29 Available
Att4d FG Consent Cat2.docx Supplementary Document Uploaded 2016-08-29 Repair queued
Att4c FG Consent Cat 1.docx Supplementary Document Uploaded 2016-08-29 Available
Att4b PI Consent Cat 2.docx Supplementary Document Uploaded 2016-08-29 Available
Att4a PI Consent Cat1.docx Supplementary Document Uploaded 2016-08-29 Available
Att 2 60 Day FRN.pdf Supplementary Document Uploaded 2016-08-29 Available
Att 1 Legislative Authority.pdf Supplementary Document Uploaded 2016-08-29 Repair queued
SSB.docx Supporting Statement B Uploaded 2017-03-17 Available
SSA.docx Supporting Statement A Uploaded 2017-03-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
223247 Staff Interview Category 2 Other-Interview Guide New
223246 Focus Group Guide Category 2 Other-Focus Group Guide New
223245 Focus Group Questionnaire Category 2 Form New
223244 Focus Group Eligibility Screener Category 2 Form New
223242 Follow-up Interviews Category 2 Form New
223241 Baseline Interview Category 2 Form New
223240 CBO-HPS Referrals Category 2 Instruction New
223239 Medical Record Abstraction Category 2 Instruction New
223238 Interview Eligibility Screener Category 2 Form New
223237 Data Submission Categories 1 and 2 Instruction New
223236 Staff Interview Category 1 Other-Interview Guide New
223235 Focus Group Guide Category 1 Other-Focus Group Guide New
223234 Focus Group Questionnaire Category 1 Form New
223233 Focus Group Eligibility Screener Category 1 Form and Instruction New
223232 Follow-up Interviews Category 1 Form New
223231 Baseline Interview Category 1 Form New
223230 CBO-HPS Referrals Category 1 Instruction New
223229 Medical Record Abstraction Category 1 Instruction New
223228 Interview Eligibility Screener Category 1 Form New
ICR Details
0920-1172 201608-0920-016
Historical Active
HHS/CDC 16AHI
Community-based Organization Outcome Monitoring Projects for CBO HIV Prevention Services Clients
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/17/2017
Retrieve Notice of Action (NOA) 08/31/2016
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved
4,378 0 0
1,265 0 0
0 0 0
The goal is to conduct enhanced outcome monitoring of HIV-positive clients and high-risk HIV negative clients at CDC-funded community-based organizations (CBOs) over time to increase understanding of HIV prevention and support services they receive, the outcomes of these services, and successes and challenges.
US Code: 42 USC 242 Name of Law: PHSA
  
None
Not associated with rulemaking
  81 FR 26795 05/04/2016
81 FR 59630 08/30/2016
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 4,378 0 0 4,378 0 0
Annual Time Burden (Hours) 1,265 0 0 1,265 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR. Burden total is off by one hour due to rounding.
$2,134,519
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
08/31/2016