NHBS Screening (All Respondent Groups)

National HIV Behavioral Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0770 NHBS Screening (All Respondent Groups) Form and Instruction
0920-0770 Eligibility Screener (English) Att 3a_Eligibility Screener_Eng.docx Form and Instruction
0920-0770 Eligibility Screener (Spanish) Att 4a_Eligibility Screener_Span.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NHBS Screening (All Respondent Groups)	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 and Instruction	0920-0770	Eligibility Screener (English)	Att 3a_Eligibility Screener_Eng.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0770	Eligibility Screener (Spanish)	Att 4a_Eligibility Screener_Span.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,000	1,200	13,800
Annual IC Time Burden (Hours)	1,250	100	1,150
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.