№ lp_2_3_21108
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Structured federal public health surveillance questionnaire outlining interviewer-entered fields, recruitment classifications, respondent-driven sampling network size measures, and base eligibility criteria for participation in NHBS-BHBA health survey activities.
Program: National HIV Behavioral Surveillance System – Brief Biobehavioral HIV Assessments (NHBS-BHBA)
Attachment: #3a (English)
Document type: Quantitative base eligibility screener
Sponsoring agency: Centers for Disease Control and Prevention (CDC)
OMB control number: 0920-XXXX
Estimated public reporting burden: 1 minute per response
States referenced: Massachusetts (MA); Florida (FL)
Priority populations: MSM; PWID; HET; Other
Recruitment methods: Peer-to-peer; Respondent-driven sampling; Venue-based sampling; Virtual recruitment; Location-based method; Referrals from community partners; Other
Languages assessed: English; Spanish
Minimum age referenced: 18 years
Price: 8 / 10 USD
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SUICIDE RISK SCREENER INSTRUCTIONS
Year: 2011
Region / City: Sydney, Australia
Topic: Suicide Risk Assessment
Document Type: Instructions
Organization: National Drug and Alcohol Research Centre, University of New South Wales
Author: Deady, M., Ross, J. & Darke, S.
Target Audience: Mental health professionals, healthcare workers
Period of Validity: Not specified
Approval Date: Not specified
Date of Changes: Not specified
Please print and complete all questions. This form must be completed for all applicants PRIOR TO nursing facility (NF) admission in accordance with Federal PASRR Regulations 42 CFR § 483.106. ALL POSITIVE LEVEL I SCREENS are to be faxed to the appropriate agencies including Office of Community Choice Options (OCCO), Division of Developmental Disabilities (DDD) and/or Division of Mental Health and Addiction Services (DMHAS), as applicable. ALL 30-DAY EXEMPTED HOSPITAL DISCHARGE SCREENS are to be faxed to OCCO, DDD and/or DMHAS, as applicable. For first time identification of mental Illness (MI) and/or intellectual disability/developmental disability/related condition (ID/DD/RC), the Level I Screener must provide written notice to the applicant and/or their legal representative that MI and/or ID/DD/RC is suspected or known and that a referral is being made to DMHAS and/or DDD for a PASRR Level II Evaluation. The Notice of Referral for a PASRR Level II Evaluation form (LTC-29) can be downloaded from the New Jersey DHS, Division of Aging Services forms webpage at http://www.state.nj.us/humanservices/doas/home/forms.html
Note: . FAILURE TO ABIDE BY PASRR RULES WILL RESULT IN FORFEITURE OF MEDICAID REIMBURSEMENT TO THE NF DURING PERIOD OF NON-COMPLIANCE IN ACCORDANCE WITH FEDERAL PASRR REGULATIONS 42 CFR 483.122.
Year: N/A
Region / City: N/A
Topic: Mental Illness and Intellectual Disability Screening
Document Type: Form
Institution / Organization: New Jersey Department of Human Services
Author: N/A
Target Audience: Healthcare providers and applicants for nursing facility admission
Effective Period: N/A
Approval Date: N/A
Modification Date: N/A
Dietary Screener Questionnaire Variables and Response Codes
Topic: dietary intake frequency
Document type: survey questionnaire codebook
Population: adults
Time reference: past month
Variables: age, sex, food and beverage consumption frequency
Measurement method: self-reported frequency categories
Response format: categorical codes
Data structure: variable list with attributes and codes
Source type: health and nutrition survey instrument
Acknowledgment of Amendments and Request for Information (Q&A) – Dyslexia Screener Request for Qualifications, Amendment Number One, January 7, 2022
Document Title: Acknowledgment of Amendments and Request for Information (Q&A) – Dyslexia Screener Request for Qualifications, Amendment Number One
Date: January 7, 2022
Issuing Body: Mississippi Department of Education
Subject: Dyslexia Screener Request for Qualifications
Document Type: Amendment and Questions and Answers
Related Process: Request for Proposals / Applications / Qualifications
Relevant Law: MS Code § 37-173-15
Proposal Release Date: December 27, 2021
Deadline for Questions: January 5, 2022
Proposal Submission Deadline: January 27, 2022 at 2:00 PM CST
Anticipated Notice of Intent to Award: March 18, 2022
Approval Authority: State Board of Education
Posting Duration of Approved List: Until May 2024
Target Population: Kindergarten and Grade 1 students
Reporting Requirements: Annual reporting by school districts on screener use and results
Language Screener Record Form – KS2
Note: Year
Parental Permission and Youth Assent Screener for Teen Survey Participation
Year: 2023
Region / City: United States
Theme: Tobacco and vaping products research
Document Type: Survey screener
Organization / Institution: U.S. Food and Drug Administration, Center for Tobacco Products
Author: U.S. Food and Drug Administration
Target Audience: Parents or guardians of teens aged 13-17
Period of Validity: Not specified
Approval Date: Not specified
Modification Date: Not specified
Presentence Screener
Year: Not specified
Region / City: Not specified
Subject: Probation and Sentencing
Document Type: Job Description
Organization: Not specified
Author: Not specified
Target Audience: Not specified
Effective Period: Not specified
Approval Date: Not specified
Modification Date: Not specified
Experience Requirements: Experience in a court-related environment may substitute education requirement
Training, Certifications, and Requirements: Not specified
Working Conditions: Not specified
Supervision Received: Probation Officer Supervisors
Supervision Exercised: May provide direction to less experienced staff
Study Screener for Feeding My Baby and Me
Year: 2023
Region / City: United States
Topic: Infant Feeding Practices
Document Type: Research Study Screener
Agency / Institution: Centers for Disease Control and Prevention (CDC)
Author: Centers for Disease Control and Prevention (CDC)
Target Audience: Pregnant women in the United States
Action Period: 2 years
Approval Date: Not specified
Date of Last Revision: Not specified
Expanding PrEP in Communities of Color (EPICC+) Attachment 4n Aim 2b Provider Focus Group Screener
Note: Year
Topic: PrEP (Pre-Exposure Prophylaxis)
Document Type: Provider Focus Group Screener
Organization: CDC/ATSDR
Target Audience: Healthcare Providers
Exclusion Criteria: Participant eligibility based on PrEP service provision and training status
Inclusion Criteria: Participation in provider focus group discussions
Public Reporting Burden: Estimated 5 minutes per response
OMB Control Number: 0920-New
Expiration Date: XX/XX/XXXX
Message Testing for CDC’s Division of Community Health with the General Public and Engaged Public Discussion Group Recruitment Screener –August-September 2012
Year: 2012
Region / City: United States
Theme: Public health, community outreach, market research
Document Type: Recruitment screener
Organization: Centers for Disease Control and Prevention (CDC)
Author: Not specified
Target Audience: General public, engaged public
Duration: 1.5 hours or less per general public focus group, 60 minutes or less per engaged public triad
Approval Date: Not specified
Date of Changes: Not specified
Incentive: $50 per participant
Screening Questions: Yes
Topics Covered: Health information consumption, participation in public activities
Topics: Biobehavioral NHBS-BHBA SCREENER