Information Collection

Development of Messages for the "Let's Stop HIV Together" National Campaign

IC 244026 under ICR 201809-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Development of Messages for the "Let's Stop HIV Together" National Campaign Form and Instruction
Att 2 Web-based Survey Screener_2020-08-20.docx Other-WORD version of screening ques
Att 3 Web-Based Survey.docx Other-WORD version of survey questio
Screenshots of Screener and Survey Instrument Att 4 Screenshots of Screener and Survey_2020-10-20.docx Form and Instruction
Supporting Statement A_GenIC-Together-Prevention_12-9-2020.docx Supporting Statement Part A IC Document
Supporting Statement B_GenIC-Together-Prevention_12-3-2020.docx Supporting Statement Part B IC Document
Att 1 Consent Form.docx Consent Form (consent is embedded in the screenshots) IC Document
Att 5 Web-based Email Reminder.docx Email Reminder IC Document
Att 6 2020 PD Approval_7.16.20.pdf Project Determination: IRB Approval Not Required IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Development of Messages for the "Let's Stop HIV Together" National Campaign	Agency IC Tracking Number:	0920-21AH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Screenshots of Screener and Survey Instrument	Att 4 Screenshots of Screener and Survey_2020-10-20.docx	Yes	Yes	Fillable Fileable
Other-WORD version of screening questions to facilitate review			Att 2 Web-based Survey Screener_2020-08-20.docx	No		Paper Only
Other-WORD version of survey questions to facilitate review			Att 3 Web-Based Survey.docx	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,340	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	1,340	1,340
Annual IC Time Burden (Hours)	545	545
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A	Supporting Statement A_GenIC-Together-Prevention_12-9-2020.docx	12/09/2020
Supporting Statement Part B	Supporting Statement B_GenIC-Together-Prevention_12-3-2020.docx	12/09/2020
Consent Form (consent is embedded in the screenshots)	Att 1 Consent Form.docx	10/20/2020
Email Reminder	Att 5 Web-based Email Reminder.docx	10/22/2020
Project Determination: IRB Approval Not Required	Att 6 2020 PD Approval_7.16.20.pdf	10/22/2020

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