Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Att1_Screener.docx Other-WORD
Att3_Focus Group ModeratorGuide.docx Other-WORD
Att2_SpanishSexualHealthGuide.pdf Att 2_Spanish Sexual Health Guide IC Document
Att4_EnglishSexualHealthGuide.pdf Att 4_English Sexual Health Guide IC Document
Project Overview.docx Program Overview IC Document
Template_Screener.docx Request for Approval - Screener IC Document
Template_FocusGroup.docx Request for Approval - Focus Group IC Document
Att5_EngSpanDiscussionGuide.docx Att 5_ English Spanish Discussion Guide IC Document
Att6_ComparisonEngSpanGuide.docx Att 6_Compairson English/Spanish Guide IC Document

Information Collection (IC) Details

IC Title:	Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community	Agency IC Tracking Number:	16WA

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
Other-WORD			Att1_Screener.docx		No		Fillable Fileable
Other-WORD			Att3_Focus Group ModeratorGuide.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 2_Spanish Sexual Health Guide	Att2_SpanishSexualHealthGuide.pdf	04/13/2016
Att 4_English Sexual Health Guide	Att4_EnglishSexualHealthGuide.pdf	04/13/2016
Program Overview	Project Overview.docx	04/13/2016
Request for Approval - Screener	Template_Screener.docx	04/13/2016
Request for Approval - Focus Group	Template_FocusGroup.docx	04/13/2016
Att 5_ English Spanish Discussion Guide	Att5_EngSpanDiscussionGuide.docx	04/13/2016
Att 6_Compairson English/Spanish Guide	Att6_ComparisonEngSpanGuide.docx	04/13/2016

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