Information Collection Request

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

ICR 202403-0920-003 · OMB 0920-1402 · Received in OIRA

⚠️ Notice: This information collection may be outdated.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

2025-05-28 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form 0920-1402 In-depth Interview – Spanish (Att 6d) Form and Instruction	New
Form 0920-1402 In-depth Interview – English (Att 6c) Form and Instruction	New
Form 0920-1402 Consent for qualitative interview - Spanish (Att 5d) Form and Instruction	New
Form 0920-1402 Consent for qualitative interview– English (Att 5c) Form and Instruction	New
Form 0920-1402 SHIELD Survey (Spanish) Form and Instruction	Modified
Form 0920-1402 SHIELD Survey (English) Form and Instruction	Modified
Form 0920-1402 SHIELD Model Consent (Spanish) Form and Instruction	Modified
Form 0920-1402 SHIELD Model Consent (English) Form and Instruction	Modified
Form 0920-1402 SHIELD Model Recruitment Script (Spanish) Form and Instruction	Modified
Form 0920-1402 SHIELD Recruitment Script (English) Form and Instruction	Modified
Attachment 8 SHIELD External Consultants.docx Supplementary Document	2024-03-05
Attachment 10 Agreement To Abide by Restrictions on Release of Surveillance Data.docx Supplementary Document	2024-03-05
Attachment 3 SHIELD References.docx Supplementary Document	2024-03-05
Attachment 11 PIA-No PII Collected.pdf Supplementary Document	2024-03-05
Privacy Act Checklist.docx Supplementary Document	2024-03-05
Attachment 7 SHIELD Project Determination.docx Supplementary Document	2024-03-05
Attachment 2 SHIELD 60-Day FRN.pdf Supplementary Document	2024-03-05
Attachment 1_Authorizing Legislation.pdf Supplementary Document	2024-03-05
30dy2323HK Published.pdf Supplementary Document	2023-02-07
SSB Project Shield.docx Supporting Statement B	2024-03-05
SSA Project Shield.docx Supporting Statement A	2024-03-18
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
265790	In-depth Interview – Spanish (Att 6d) Form and Instruction	New
265789	In-depth Interview – English (Att 6c) Form and Instruction	New
265788	Consent for qualitative interview - Spanish (Att 5d) Form and Instruction	New
265787	Consent for qualitative interview– English (Att 5c) Form and Instruction	New
257895	SHIELD Survey (Spanish) Form and Instruction	Modified
257894	SHIELD Survey (English) Form and Instruction	Modified
257893	SHIELD Model Consent (Spanish) Form and Instruction	Modified
257892	SHIELD Model Consent (English) Form and Instruction	Modified
257891	SHIELD Model Recruitment Script (Spanish) Form and Instruction	Modified
257890	SHIELD Recruitment Script (English) Form and Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CDC
OMB Control No	0920-1402
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202301-0920-007
Agency Tracking No	0920-1402
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31