Att 9_Provider Screener

Formative Research to Develop HIV Social Marketing Campaigns for Healthcare Providers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1182 can be found here:

Documents and Forms

Document Name Document Type
Att 9 Provider Screener.docx Other-WORD

Information Collection (IC) Details

IC Title:	Att 9_Provider Screener	Agency IC Tracking Number:	16TZ

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
Other-WORD			Att 9 Provider Screener.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	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.