MSM AYA Stakeholder Analysis Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
MSM AYA Stakeholder Analysis Survey Form and Instruction
Stakeholder Analysis Adolescent Online Survey Revise Att1 Stakeholder Analysis Adolescent Survey.docx Form and Instruction
Stakeholder Analysis MSM Online Survey Att2 Stakeholder Analysis MSM Survey 23JUL2015.docx Form and Instruction
Request - MSM AYA Stakeholder Analysis Survey Generic Qualitative Feedback 23JUL2015.docx Request for GenIC Approval 0920-1027 IC Document
IRB Approval MSM-AYA Study #1.pdf IRB Approval Study #1 IC Document
Recruitment Plan for MSM and AYA Stakeholder Assessment Survey Updated 4.28.15.docx Recruitment Plan for MSM/AYA Stakeholder Survey IC Document

Information Collection (IC) Details

IC Title:	MSM AYA Stakeholder Analysis Survey	Agency IC Tracking Number:	15AMC

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
Form and Instruction	NA	Stakeholder Analysis MSM Online Survey	Att2 Stakeholder Analysis MSM Survey 23JUL2015.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Stakeholder Analysis Adolescent Online Survey	Revise Att1 Stakeholder Analysis Adolescent Survey.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	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	150	150
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for GenIC Approval 0920-1027	Request - MSM AYA Stakeholder Analysis Survey Generic Qualitative Feedback 23JUL2015.docx	07/29/2015
IRB Approval Study #1	IRB Approval MSM-AYA Study #1.pdf	07/29/2015
Recruitment Plan for MSM/AYA Stakeholder Survey	Recruitment Plan for MSM and AYA Stakeholder Assessment Survey Updated 4.28.15.docx	07/29/2015

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