Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Counseling, Testing and Referral for Community-Based Organizations New 280 6440 0 Form and Instruction None Counseling, Testing and Referral Form
Form and Instruction None Reverse Side of CTR Form with Codes
Counseling, Testing and Referral for Health Jurisdictions (CTR scan) New 120 61080 0 Form and Instruction None Counseling, Testing and Referral Form
Form and Instruction None Reverse Side of CTR Form with Codes
PEMS Data Collection for Community-Based Organizations New 640 53760 0 Form and Instruction None PEMS Data Variables and Values for CBOs
PEMS Data Collection for Community-Based Organizations (Training) New 640 6400 0 Form and Instruction None PEMS Data Variables and Values for CBOs
PEMS Data Collection for Health Jurisdictions Modified 236 32332 0 Form and Instruction None PEMS Data Variables and Values for Health Departments
PEMS Data Collection for Health Jurisdictions (CTR non-scan) New 116 19140 0 Form and Instruction None PEMS Data Variables and Values for Health Departments
PEMS Data Collection for Health Jurisdictions (Training) New 236 2360 0 Form and Instruction None PEMS Data Variables and Values for Health Departments
Total burden requested under this ICR: 2268 181512 0  
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