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Objectives 1 and 2 ACASI Questionaire
Incident HIV/ Hepatitis B virus infections in South African blood donors:Behavioral risk factors, genotypes and biological characterization of early infection (NHLBI)
OMB: 0925-0699
IC ID: 210551
OMB.report
HHS/NIH
OMB 0925-0699
ICR 201402-0925-003
IC 210551
( )
Documents and Forms
Document Name
Document Type
Form 1
Objectives 1 and 2 ACASI Questionaire
Form and Instruction
1 ACASI Questionaire
Attachment 2A HIV_HBV_Objectives_1_2_ACASI_Q_12_2013_V_1.0.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Objectives 1 and 2 ACASI Questionaire
Agency IC Tracking Number:
Is this a Common Form?
No
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 and Instruction
1
ACASI Questionaire
Attachment 2A HIV_HBV_Objectives_1_2_ACASI_Q_12_2013_V_1.0.docx
No
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:
483
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
483
0
483
0
0
0
Annual IC Time Burden (Hours)
274
0
274
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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Document
Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.