OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)

ICR 202503-0920-026 · OMB 0920-1402 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1402 In-depth Interview – Spanish (Att 6d) Form and Instruction Unchanged Missing upstream
Form 0920-1402 In-depth Interview – English (Att 6c) Form and Instruction Modified Repair queued
Form 0920-1402 Consent for qualitative interview - Spanish (Att 5d) Form and Instruction Unchanged Repair queued
Form 0920-1402 Consent for qualitative interview– English (Att 5c) Form and Instruction Unchanged Repair queued
Form 0920-1402 SHIELD Survey (Spanish) Form and Instruction Modified Missing upstream
Form 0920-1402 SHIELD Survey (English) Form and Instruction Modified Repair queued
Form 0920-1402 SHIELD Model Consent (Spanish) Form and Instruction Unchanged Repair queued
Form 0920-1402 SHIELD Model Consent (English) Form and Instruction Unchanged Repair queued
Form 0920-1402 SHIELD Model Recruitment Script (Spanish) Form and Instruction Unchanged Repair queued
Form 0920-1402 SHIELD Recruitment Script (English) Form and Instruction Unchanged Repair queued
Justification Memo for Nonsubstantive Change Req_0920-1402 SHIELD.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-28 Repair queued
Attachment 8 SHIELD External Consultants.docx Supplementary Document Uploaded 2024-03-05 Repair queued
Attachment 10 Agreement To Abide by Restrictions on Release of Surveillance Data_clean.docx Supplementary Document Uploaded 2025-03-28 Repair queued
Attachment 3 SHIELD References.docx Supplementary Document Uploaded 2024-03-05 Available
Attachment 11 PIA-No PII Collected.pdf Supplementary Document Uploaded 2024-03-05 Repair queued
Privacy Act Checklist.docx Supplementary Document Uploaded 2024-03-05 Missing upstream
Attachment 7 SHIELD Project Determination.docx Supplementary Document Uploaded 2024-03-05 Missing upstream
Attachment 2 SHIELD 60-Day FRN.pdf Supplementary Document Uploaded 2024-03-05 Repair queued
Attachment 1_Authorizing Legislation.pdf Supplementary Document Uploaded 2024-03-05 Repair queued
SSB Project Shield_clean.docx Supporting Statement B Uploaded 2025-03-28 Missing upstream
SSA Project Shield_clean.docx Supporting Statement A Uploaded 2025-03-28 Repair queued
Attachment 9 Assurance of Confidentiality for HIV Surveillance.docx Supplementary Document Uploaded 2025-03-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
265790 In-depth Interview – Spanish (Att 6d) Form and Instruction Unchanged
265789 In-depth Interview – English (Att 6c) Form and Instruction Modified
265788 Consent for qualitative interview - Spanish (Att 5d) Form and Instruction Unchanged
265787 Consent for qualitative interview– English (Att 5c) Form and Instruction Unchanged
257895 SHIELD Survey (Spanish) Form and Instruction Modified
257894 SHIELD Survey (English) Form and Instruction Modified
257893 SHIELD Model Consent (Spanish) Form and Instruction Unchanged
257892 SHIELD Model Consent (English) Form and Instruction Unchanged
257891 SHIELD Model Recruitment Script (Spanish) Form and Instruction Unchanged
257890 SHIELD Recruitment Script (English) Form and Instruction Unchanged
ICR Details
0920-1402 202503-0920-026
Received in OIRA 202403-0920-003
HHS/CDC 0920-25-0056
[NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)
No material or nonsubstantive change to a currently approved collection   No
Regular 05/28/2025
  Requested Previously Approved
05/31/2027 05/31/2027
7,700 7,700
3,074 3,074
0 0
Project SHIELD (Surveillance of HIV-related service barriers among individuals with early or late HIV diagnoses) is a project to assess barriers and facilitators to HIV testing and HIV prevention strategies, including PrEP, with the goal of prioritizing interventions and efforts to prevent infections and facilitate early diagnosis and linkage to care. The enhanced surveillance will be conducted in collaboration with four US health departments who will use their HIV surveillance data to generate lists of potentially eligible participants. Eligible participants will be interviewed by a contractor funded by CDC. This change request complies with recent executive orders.
US Code: 42 USC 241 Name of Law: U.S. PHSA
  
None
Not associated with rulemaking
  88 FR 69640 10/06/2023
89 FR 7711 02/05/2024
No
  Total Request 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 7,700 7,700 0 0 0 0
Annual Time Burden (Hours) 3,074 3,074 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The purpose of this data collection is to describe the health-related behaviors, experiences, and needs of adults diagnosed with HIV in the United States. CDC is requesting approval for 3,074 burden hours and three years of approval.
$2,370,027
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Kevin Joyce 404 639-1944 [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.
05/28/2025