Partner Services Paper and Pencil Questionnaire

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
Partner Services Paper and Pencil Questionnaire Form
Partner Services Paper and Pencil Questionnaire A7c Paper and Pencil Survey-Partner Services.docx Form

Information Collection (IC) Details

IC Title:	Partner Services Paper and Pencil Questionnaire	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	Partner Services Paper and Pencil Questionnaire	A7c Paper and Pencil Survey-Partner Services.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	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	26	-32	58
Annual IC Time Burden (Hours)	4	-6	10
Annual IC Cost Burden (Dollars)	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.