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Harm Reduction Point in Time Survey PILOT
 
New
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Point in Time Reduction Survey Paper Version Point in Time Reduction Survey Paper Version Appendix B1_PAPER_Pilot_3-29-24_CLEAN_Response_4-09-24.docx Yes Yes Fillable Fileable
Form and Instruction Point in Time Reduction Survey Tablet Version Point in Time Reduction Survey Tablet Version Appendix B2_TABLET_Pilot_3-29-24_CLEAN_Response_4-09-24.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)  75 FR 28264

26 0
   
State, Local, and Tribal Governments
 
   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 26 0 26 0 0 0
Annual IC Time Burden (Hours) 18 0 18 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Survey Consent Form HR PIT PILOT Appendix A - Survey Consent Form 03142024.docx 04/30/2024
Incentive Tracking and Acknowledgement HR PIT PILOT Appendix C - PiT HR Survey Incent Track Acknowl_03142024.docx 04/30/2024
Survey Checklist HR PIT PILOT Appendix D - PiT HR Survey Checklist_03142024.docx 04/30/2024
Survey Recruitment Script HR PIT PILOT Appendix E - PiT HR Survey Recruitment Script_03142024.docx 04/30/2024
Daily Outreach Refusal Tracking Form HR PIT PILOT Appendix F - PiT Survey Daily Outreach Refusal Track_03142024.docx 04/30/2024
Survey Participant Tracking HR PIT PILOT Appendix G - PiT HR Survey Participant Tracking_03142024.docx 04/30/2024
Debriefing Interview Guide HR PIT PILOT Appendix H - Pilot Debriefing Interview Guide_03142024.docx 04/30/2024
Tablet User Agreement Appendix I - Tablet User Agreement _Pilot_3-29-24_CLEAN.docx 04/30/2024
Confidentiality Agreement HR PIT PILOT Appendix J - Confidentiality Agreement_03142024.docx 04/30/2024
Training Protocols HR PIT PILOT Attachment 1 Training_Protocols 03142024.docx 04/30/2024
Point in Time Harm Reduction PILOT Generic Request Template HR PIT PILOT SAMHSA Research_ Assess_ Generic Request_04152024_clean.docx 04/30/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.