Information Collection Request

[NCHHSTP] Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)

ICR 202301-0920-007 · OMB 0920-1402 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1402 can be found here:

Forms and Documents

Document Name	Status
Form 0920- SHIELD Survey (Spanish) Form	New
Form 0920- SHIELD Survey (English) Form	New
Form 0920- SHIELD Model Consent (Spanish) Form	New
Form 0920- SHIELD Model Consent (English) Form	New
Form 0920- SHIELD Model Recruitment Script (Spanish) Form	New
Form 0920- SHIELD Recruitment Script (English) Form	New
30dy2323HK Published.pdf Supplementary Document	2023-02-07
SSB Project Shield .docx Supporting Statement B	2023-01-18
SSA Project Shield_22HK CB.docx Supporting Statement A	2023-01-18
Att 11_Agreement To Abide by Restrictions on Release of Surveillance Data.docx Supplementary Document	2023-01-18
Att 10_Assurance of Confidentiality for HIV Surveillance.docx Supplementary Document	2023-01-18
Att 9_SHIELD External Consultants.docx Supplementary Document	2023-01-18
Att 7_SHIELD Project Determination.docx Supplementary Document	2023-01-12
Att 3_SHIELD References.docx Supplementary Document	2023-01-12
Att 1_Authorizing Legislation.pdf Supplementary Document	2023-01-12

IC Document Collections

IC ID	Document Title	Status
257895	SHIELD Survey (Spanish) Form	New
257894	SHIELD Survey (English) Form	New
257893	SHIELD Model Consent (Spanish) Form	New
257892	SHIELD Model Consent (English) Form	New
257891	SHIELD Model Recruitment Script (Spanish) Form	New
257890	SHIELD Recruitment Script (English) Form	New

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CDC
OMB Control No	0920-1402
Type of Information Collection	New collection (Request for a new OMB Control Number)
Agency Tracking No	0920-22HK
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31