View Information Collection (IC)

View Information Collection (IC)

IC Title:	Usability Pilot Test of the ARCH Digital Application for HIV Prevention Providers	Agency IC Tracking Number:	0920-0840-20BQ

IC Status: New

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	Assessment survey -word	Att1_App Assessment Survey_Word.docx		Yes	Yes	Fillable Fileable
Form	none	Assessment survey - screenshots	Att3_App Assessment Survey Screenshots.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	300	0	300	0	0	0
Annual IC Time Burden (Hours)	125	0	125	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement B	Supporting Statement B.docx	01/21/2021
Email invitation	Att2_Email Scripts.docx	01/21/2021
Supporting Statement A	Supporting Statement A.docx	02/08/2021

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