Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the MMP
Agency IC Tracking Number:
0920-0840 (18ACM)
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
0920-0840
Interview Guide
Att 1_Interview Guide.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
40
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
40
0
40
0
0
0
Annual IC Time Burden (Hours)
40
0
40
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
Supporting Statement A.docx
04/24/2018
Supporting Statement B
Supporting Statement B.docx
04/24/2018
Att 2 Recruitment Script
Att 2_Recruitment Script.docx
04/24/2018
Att 3 Verbal Informed Consent
Att 3_Verbal Informed Consent.docx
04/24/2018
Att 4 Assurance of Confidentiality
Att 4_Assurance of Confidentiality.pdf
04/24/2018
Att 5 Project Determination
Att 5_Project Determination.pdf
04/24/2018
Att 6_Agreement to Abide by Restrictions
Att 6_AgreementToAbide by Restrictions.docx
04/24/2018
Att 7 Privacy Impact Assessment
Att 7_Privacy Impact Assessment.pdf
04/24/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.