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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs)
Agency IC Tracking Number:
0920-0572-22GF
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
0920-0572
Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Survey
Attachment C-FBO Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0572
Syringe Service Programs (SSPs) Communication Toolkit - Faith-Based Organizations (FBOs) Screener
Attachment B-FBO Screener_revised 081022.docx
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:
600
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
600
0
600
0
0
0
Annual IC Time Burden (Hours)
260
0
260
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSPs Communication Toolkit--FBOs: Project Summary
Attachment A-Project Summary.docx
06/13/2022
IRB Determination
Attachment E-IRB Determination.pdf
06/13/2022
HMTS Expedited Review Form (SSPs Communication Toolkit-FBOs)
_HMTSExpeditedReviewForm.pdf
06/13/2022
Burden Hour Calculations sheet
Attachment D-Burden Hour Calculations_rev.docx
06/16/2022
List of Attachments
_List of Attachments.rev.docx
06/16/2022
Attachment F_Screenshots (FBO Survey)
Attachment F_Screenshot (FBO Survey).docx
06/16/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.