Developing Tools to Engage Adolescent Men Who Have Sex with Men (AMSM)

Formative Research and Tool Development

OMB: 0920-0840

IC ID: 228556

Documents and Forms
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Information Collection (IC) Details

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Developing Tools to Engage Adolescent Men Who Have Sex with Men (AMSM) 0920-17AZE
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Screener for In-person AMSM and Transgender Focus Groups Att 3a. Screener (In-Person Focus Groups).docx No   Paper Only
Form n/a Screener for Online AMSM and Transgender Focus Groups Att 3a. Screenshots of Screener (Online Focus Groups).docx Yes Yes Fillable Fileable
Form and Instruction n/a AMSM Focus Group Guide Att 3b. AMSM Focus Group Guide.docx No   Paper Only
Form n/a Screenshots of AMSM Focus Group Guide Att 3b. Screenshots of AMSM Focus Group Guide.docx Yes Yes Fillable Fileable
Form and Instruction n/a Transgender Youth Focus Group Guide Att 3c. Transgender Youth Focus Group Guide.docx No   Paper Only
Form n/a Screenshots of Transgender Youth Focus Group Guide Att 3c. Screenshots of Transgender Youth Focus Group Guide.docx Yes Yes Fillable Fileable

Health Illness Prevention

09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems. HHS/CDC  57 FR 62812

72 0
   
Individuals or Households
 
   67 %

  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 72 0 72 0 0 0
Annual IC Time Burden (Hours) 198 0 198 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Part A SSA.docx 10/04/2017
Supporting Statement Part B SSB.docx 10/04/2017
Federal Register Notice Att 2--Federal Register Notice.pdf 10/04/2017
Informed Consent for Participants 18 and Over Att 4a. Informed Consent.docx 10/04/2017
Screenshots of Informed Assent or Consent Att 4a. 4b. Screenshots of Informed Assent Forms.docx 10/04/2017
Waiver or Alteration of Informed Consent Att 4c. Waiver Informed Consent.doc 10/04/2017
Waiver of Parental Permission Att 4d. Waiver of Parental Permission.doc 10/04/2017
Waiver of HIPAA Authorization Att 4e. Waiver HIPAA Authorization.doc 10/04/2017
Procedure for Reporting Suspected Child Abuse Att 4f. Procedure for Reporting Child Abuse.doc 10/04/2017
Recruitment Advertisements Att 5a. Focus Group Recruitment Ads.pptx 10/04/2017
Online Recruitment Ad Language Att 5b. Recruitment Language.docx 10/04/2017
IRB Approval Letter Att 6a. The Fenway Institute IRB Approval Letter.pdf 10/04/2017
Informed Assent for Participants Under 18 Years of Age Att 4b. Informed Assent.docx 10/05/2017
CDC Research Project Determination Form Att 6b. CDC HumanSubject Project Determination_2017.10.06.pdf 10/06/2017
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