OMB control number

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

OMB 0920-1402 · HHS/CDC.

OMB 0920-1402

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1402 In-depth Interview – Spanish (Att 6d) Form and Instruction
Form 0920-1402 In-depth Interview – English (Att 6c) Form and Instruction
Form 0920-1402 Consent for qualitative interview - Spanish (Att 5d) Form and Instruction
Form 0920-1402 Consent for qualitative interview– English (Att 5c) Form and Instruction
Form 0920-1402 SHIELD Survey (Spanish) Form and Instruction
Form 0920-1402 SHIELD Survey (English) Form and Instruction
Form 0920-1402 SHIELD Model Consent (Spanish) Form and Instruction
Form 0920-1402 SHIELD Model Consent (English) Form and Instruction
Form 0920-1402 SHIELD Model Recruitment Script (Spanish) Form and Instruction
Form 0920-1402 SHIELD Recruitment Script (English) Form and Instruction
Justification Memo for Nonsubstantive Change Req_0920-1402 SHIELD.docx Justification for No Material/Nonsubstantive Change
Attachment 8 SHIELD External Consultants.docx Supplementary Document
Attachment 10 Agreement To Abide by Restrictions on Release of Surveillance Data_clean.docx Supplementary Document
Attachment 3 SHIELD References.docx Supplementary Document
Attachment 11 PIA-No PII Collected.pdf Supplementary Document
Privacy Act Checklist.docx Supplementary Document
Attachment 7 SHIELD Project Determination.docx Supplementary Document
Attachment 2 SHIELD 60-Day FRN.pdf Supplementary Document
Attachment 1_Authorizing Legislation.pdf Supplementary Document
SSB Project Shield_clean.docx Supporting Statement B
SSA Project Shield_clean.docx Supporting Statement A
Attachment 9 Assurance of Confidentiality for HIV Surveillance.docx Supplementary Document
In-depth Interview – Spanish (Att 6d) Form and Instruction
In-depth Interview – English (Att 6c) Form and Instruction
Consent for qualitative interview - Spanish (Att 5d) Form and Instruction
Consent for qualitative interview– English (Att 5c) Form and Instruction
SHIELD Survey (Spanish) Form and Instruction
SHIELD Survey (English) Form and Instruction
SHIELD Model Consent (Spanish) Form and Instruction
SHIELD Model Consent (English) Form and Instruction
SHIELD Model Recruitment Script (Spanish) Form and Instruction
SHIELD Recruitment Script (English) Form and Instruction

All Historical Document Collections

202503-0920-026	No material or nonsubstantive change to a currently approved collection	2025-05-28
202403-0920-003 Approved with change	Revision of a currently approved collection	2024-03-22
202301-0920-007 Approved without change	New collection (Request for a new OMB Control Number)	2023-02-10