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Partner Services Study Screener
Formative Research to Develop Social Marketing Campaigns-Routine HIV Testing For Emergency Medicine Physicians, Prevention Is Care, and Partner Services
OMB: 0920-0775
IC ID: 183187
OMB.report
HHS/CDC
OMB 0920-0775
ICR 201104-0920-002
IC 183187
( )
Documents and Forms
Document Name
Document Type
Partner Services Study Screener
Form
Patner Services Screener
A6c Screening Instruments-Partner Services.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Partner Services Study Screener
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
Patner Services Screener
A6c Screening Instruments-Partner Services.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
39
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
39
0
-48
0
0
87
Annual IC Time Burden (Hours)
7
0
-8
0
0
15
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.