Information Collection

African American Women's Perceptions of a Social Marketing Campaign to Promote HIV Testing

IC 207674 under ICR 201403-0920-004 · OMB 0920-0920.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
African American Women's Perceptions of a Social Marketing Campaign to Promote HIV Testing Form
Screener Att 3_ Screener.pdf Form
Survey Att 2_Survey_07-03-2013.pdf Form
Att 4_ Consent Form.pdf Consent IC Document
Att 5_Survey Reminder E-Mails.docx Survey Emails IC Document
Att 6_TCTT Creative_REV 07-03-2013.pdf Campaign Materials IC Document
SSB.docx Supporting Statement B IC Document
SSA_CLEAN_07-03-2013.docx Supporting Statement A IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	African American Women's Perceptions of a Social Marketing Campaign to Promote HIV Testing	Agency IC Tracking Number:

IC Status: Unchanged

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	none	Screener	Att 3_ Screener.pdf		Yes	Yes	Fillable Fileable
Form	none	Survey	Att 2_Survey_07-03-2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 466	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	466	466
Annual IC Time Burden (Hours)	109	109
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent	Att 4_ Consent Form.pdf	07/03/2013
Survey Emails	Att 5_Survey Reminder E-Mails.docx	07/03/2013
Campaign Materials	Att 6_TCTT Creative_REV 07-03-2013.pdf	07/08/2013
Supporting Statement B	SSB.docx	07/03/2013
Supporting Statement A	SSA_CLEAN_07-03-2013.docx	07/08/2013

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