HIV Knowledge, Beliefs, Attitudes, and Practices of Providers in the Southeast

Forms and Documents

Document Name	Status
Provider Follow-up Survey Form	New
Provider Baseline Survey Form	New
Att8_Altarium Secured Network_27jan2017.docx Supplementary Document	2017-01-31
Att7_Examples of CE Courses.docx Supplementary Document	2016-07-21
Att6 IRB Approval Ltr.docx Supplementary Document	2016-07-21
Att5i_Post-Test Survey Email Reminder.docx Supplementary Document	2016-07-21
Att5h_Phone Reminder Script.docx Supplementary Document	2016-07-21
Att5g_Postcard Reminder.docx Supplementary Document	2016-07-21
Att5f_Email Reminder.docx Supplementary Document	2017-01-31
Att5e_Consent Cover Letter.docx Supplementary Document	2017-01-31
Att5d_Email Invitation Letter.docx Supplementary Document	2016-07-21
Att5c_Postal Invitation Letter.docx Supplementary Document	2017-01-31
Att5b_Phone Recruitment Script.docx Supplementary Document	2016-07-21
Att5a_Recruitment Email.docx Supplementary Document	2017-01-31
Att4_CE Materials Email.docx Supplementary Document	2016-07-21
Att2a_Public Comment.docx Supplementary Document	2016-07-21
Att2_60 Day FRN.pdf Supplementary Document	2016-07-21
Att 1_Auth Legislation.docx Supplementary Document	2016-07-21
Sup Statement B.docx Supporting Statement B	2016-07-21
Sup Statement A_CLEAN_OMB_29Jan2017.docx Supporting Statement A	2017-01-31

IC Document Collections

IC ID	Document Title	Status
222569	Provider Follow-up Survey Form	New
222568	Provider Baseline Survey Form	New

ICR Details

OMB Control No: 0920-1160	ICR Reference No: 201607-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16VB
Title: HIV Knowledge, Beliefs, Attitudes, and Practices of Providers in the Southeast
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/01/2017
	Date Received in OIRA: 07/28/2016
Terms of Clearance: Approved consistent with the understanding that any incentives offered to respondents will be provided conditional to completion of the survey (i.e., after the survey is completed).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	12 Months From Approved
Responses	2,741	0	0
Time Burden (Hours)	1,219	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the project is to address disparities and missed opportunities for HIV prevention between primary providers and their clients by assessing the knowledge, beliefs, attitudes, and practices of primary health care providers according to HIV prevention domains in 6 MSAs in the Southeast US.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 15725	03/24/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 48798	07/26/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Provider Baseline Survey	none, none	Baseline survey ,   Baseline Screener and Survey Screenshots
Provider Follow-up Survey	none, none	Follow-up Survey ,   Follow-up Survey Screenshots

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,741	0	0	2,741	0	0
Annual Time Burden (Hours)	1,219	0	0	1,219	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $349,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/28/2016

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