Evaluation Models to Assess Patient Perspectives on Opt-out HIV Testing in Clinical Settings

Forms and Documents

Document Name	Status
Patient Survey Form	New
Final Supporting Statement B .doc Supporting Statement B	2009-02-19
0920-08BFAtt 8 References.doc Supplementary Document	2009-02-12
0920-08BFAtt 7 Model Consent.doc Supplementary Document	2009-02-12
0920-08BFAtt 6 Assurance of Confidentiality.doc Supplementary Document	2009-02-12
0920-08BFAtt 5 Non Research Determination.doc Supplementary Document	2009-02-12
0920-08BFAtt 4 Consultants.doc Supplementary Document	2009-02-12
0920-08BFAtt 2b Comment to FRN.doc Supplementary Document	2009-02-12
0920-08BFAtt 1 PHSA.pdf Supplementary Document	2009-02-12
0920-08BFAtt 2a Initial 60 Day FRN.pdf Supplementary Document	2009-02-12
Final Supporting Statement A .doc Supporting Statement A	2009-02-18

IC Document Collections

IC ID	Document Title	Status
188353	Patient Survey Form	New

ICR Details

OMB Control No: 0920-0810	ICR Reference No: 200903-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation Models to Assess Patient Perspectives on Opt-out HIV Testing in Clinical Settings
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 without change	Conclusion Date: 05/29/2009
	Date Received in OIRA: 03/10/2009
Terms of Clearance: Approved consistent with the understanding that the final package - with any changes based on this pilot - will be submitted to OMB for review and approval prior to including in a national tookit and implementing in all AETCs.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	12 Months From Approved
Responses	450	0	0
Time Burden (Hours)	150	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This project is to support the development and dissemination of administrative tools and other educational and training materials needed to implement the revised guidelines through a model evaluation toolkit for providers to assess attitudes, reactions, and acceptance of HIV screening by patients.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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:
	73 FR 33823	06/13/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 7066	02/12/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Patient Survey	None	Patient Survey

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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	450	0	0	450	0	0
Annual Time Burden (Hours)	150	0	0	150	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: $533,507

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 03/10/2009

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