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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing
Agency IC Tracking Number:
0920-1050-17ASX
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 and Instruction
NA
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide
Att1_Interview Form_Provider_REVISED_20170420v3.1.docx
NA
No
Paper Only
Form and Instruction
NA
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide
Att2_Interview Form_Data-Clinic Manager_REVISED_20170420v1.0.docx
NA
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:
25
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
25
0
25
0
0
0
Annual IC Time Burden (Hours)
25
0
25
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC Request Template - 0920-1050
Generic Clearance for Qualitative Feedback Template Approval Form.docx
06/15/2017
0920-1050 GenIC Summary
2017_STD Partner Feedback Assessment Summary.docx
06/16/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.