Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Counseling, Testing and Referral for Community-Based Organizations Modified 280 6440 0 Form and Instruction None Counseling, Testing and Referral Form
Form and Instruction None Reverse Side of CTR Form with Codes
Form and Instruction No name HIV Test Form 1 new version
Counseling, Testing and Referral for Health Jurisdictions (CTR scan) Modified 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 Modified 640 53760 0 Form and Instruction None PEMS Data Variables and Values for CBOs
PEMS Data Collection for Community-Based Organizations (Training) Modified 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) Modified 116 19140 0 Form and Instruction None PEMS Data Variables and Values for Health Departments
PEMS Data Collection for Health Jurisdictions (Training) Modified 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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