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HIV Testing and Counseling Baseline & 3-Month Follow-up
Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA
OMB: 0920-0872
IC ID: 194317
OMB.report
HHS/CDC
OMB 0920-0872
ICR 201008-0920-009
IC 194317
( )
Documents and Forms
Document Name
Document Type
Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc
Other-Cover Page
Attachment 7a_NYS Informed Consent HIV Testing.pdf
Other-Informed Consent
Attachment 7b_NYS HIV Testing Flowchart.pdf
Process Flowchart
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HIV Testing and Counseling Baseline & 3-Month Follow-up
Agency IC Tracking Number:
Is this a Common Form?
No
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-Cover Page
Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc
Yes
No
Fillable Fileable
Other-Informed Consent
Attachment 7a_NYS Informed Consent HIV Testing.pdf
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
400
0
400
0
0
0
Annual IC Time Burden (Hours)
300
0
300
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Process Flowchart
Attachment 7b_NYS HIV Testing Flowchart.pdf
08/03/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.