Emergency Departments Material Testing Interview

Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services

Documents and Forms

Document Name Document Type
Emergency Departments Material Testing Interview Form
Emergency Department HIV Testing Interview A2a Data Collection Instruments-Routine Testing.docx Form
A5a_Consent Forms-RT_3-1-11.doc Consent for Routine Testing Interview IC Document

Information Collection (IC) Details

IC Title:	Emergency Departments Material Testing Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Emergency Department HIV Testing Interview	A2a Data Collection Instruments-Routine Testing.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8	-16	24
Annual IC Time Burden (Hours)	8	-16	24
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Consent for Routine Testing Interview	A5a_Consent Forms-RT_3-1-11.doc	03/23/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.