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⚠️ Notice: This information collection may be referencing outdated material.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: Unchanged

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	Invitation - General Population	Act Against AIDS - Script Invitation for Eligible.docx	No	No	Paper Only
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

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,420	1,420
Annual IC Time Burden (Hours)	385	385
Annual IC Cost Burden (Dollars)	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.