Act Against AIDS Campaign

CDC and ATSDR Health Message Testing System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
Act Against AIDS Campaign Form and Instruction
Screener - MSM Act Against AIDS - MSM Screening Instrument.docx Form and Instruction
Interview - MSM Act Against AIDS - MSM Interview Guide.docx Form and Instruction
Screener - HIV+ Act Against AIDS - HIV+ Screening Instrument.docx Form and Instruction
Interview - HIV+ Act Against AIDS - HIV+ Interview Guide.docx Form and Instruction
Interview - General Population Act Against AIDS - Intercept Interview Guide.docx Form and Instruction
Invitation - General Population Act Against AIDS - Script Invitation for Eligible.docx Form and Instruction
Act Against AIDS - SCRIPT FOR INELIGIBLE PARTICIPANTS.docx Script for Ineligible Participants IC Document
Act Against AIDS - MSM Consent form.docx Consent for MSM Audiences IC Document
Act Against AIDS - HIV+ Consent Form.docx Consent for HIV+ Audiences IC Document
Att 3 - Health Message Testing System Expedited Review Form 1 DHAP PCB.docx Health Message Testing Review Form IC Document
Creative genIC 0920-0572.docx Messages IC Document

Information Collection (IC) Details

IC Title:	Act Against AIDS Campaign	Agency IC Tracking Number:

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	none	Screener - MSM	Act Against AIDS - MSM Screening Instrument.docx	No	No	Paper Only
Form and Instruction	none	Interview - MSM	Act Against AIDS - MSM Interview Guide.docx	No	No	Paper Only
Form and Instruction	none	Screener - HIV+	Act Against AIDS - HIV+ Screening Instrument.docx	No	No	Paper Only
Form and Instruction	none	Interview - HIV+	Act Against AIDS - HIV+ Interview Guide.docx	No	No	Paper Only
Form and Instruction	none	Interview - General Population	Act Against AIDS - Intercept Interview Guide.docx	No	No	Paper Only
Form and Instruction	none	Invitation - General Population	Act Against AIDS - Script Invitation for Eligible.docx	No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,420	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	1,420	0	0	0	0	0
Annual IC Time Burden (Hours)	385	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Script for Ineligible Participants	Act Against AIDS - SCRIPT FOR INELIGIBLE PARTICIPANTS.docx	02/06/2012
Consent for MSM Audiences	Act Against AIDS - MSM Consent form.docx	02/06/2012
Consent for HIV+ Audiences	Act Against AIDS - HIV+ Consent Form.docx	02/06/2012
Health Message Testing Review Form	Att 3 - Health Message Testing System Expedited Review Form 1 DHAP PCB.docx	02/06/2012
Messages	Creative genIC 0920-0572.docx	02/06/2012

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