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Web-based CBO Assessment
Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs
OMB: 0920-1084
IC ID: 216050
OMB.report
HHS/CDC
OMB 0920-1084
ICR 201504-0920-004
IC 216050
( )
Documents and Forms
Document Name
Document Type
Web-based CBO Assessment
Form and Instruction
District Partner Assessment - CBO
Att 5 DASH YMSM Web-based CBO Assessment.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Web-based CBO Assessment
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
None
District Partner Assessment - CBO
Att 5 DASH YMSM Web-based CBO Assessment.docx
None
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
30
0
30
0
0
0
Annual IC Time Burden (Hours)
30
0
30
0
0
0
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.