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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
CBO Needs Assessment for Preparedness and Resources for Support of Biomedical HIV Prevention
Agency IC Tracking Number:
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
Other-Pre-test Telephone Interview Script
Att 5 Pre-test Telephone Interview Script.docx
Yes
No
Paper Only
Form
None
Biomedical HIV Prevention Organizational Assessment Web-based Survey Screenshots
Att 9b Biomed HIV Prev Org Assessment-screenshots.docx
Yes
Yes
Fillable Fileable
Form
none
Consent Form
Att 8 Consent Form.docx
Yes
No
Paper Only
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:
895
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
895
0
0
0
0
0
Annual IC Time Burden (Hours)
323
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 6 Survey Telephone Recruitment Script
Att 6 Survey Telephone Recruitment Script.docx
04/05/2013
Att 3 Pre-test Tele Recruitment Script
Att 3 Pre-test Tele Recruitment Script.docx
04/05/2013
Att 4 Pre-test Recruitment Email
Att 4 Pre-test Recruitment Email.docx
04/05/2013
SSA
SSA.docx
04/05/2013
Att 7 Survey Email Recruitment Script
Att 7 Survey Email Recruitment Script.docx
04/05/2013
Att 9a Biomed HIV Prev Org Assessment
Att 9a Biomed HIV Prev Org Assessment.docx
04/05/2013
SSB
SSB.doc
04/05/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.