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Registration Form
National Learning Community for HIV CBO Leadership Evaluation
OMB: 0920-1370
IC ID: 250068
OMB.report
HHS/CDC
OMB 0920-1370
ICR 202110-0920-015
IC 250068
( )
Documents and Forms
Document Name
Document Type
Form 0920-
Registration Form
Form
0920- National Learning Community for HIV CBO Leadership Regis
Att 4_Registration Form.docx
Form
Att 5_Screenshots of Registration Form.docx
Screenshots of National Learning Community for HIV CBO Leadership Registration Form
IC Document
Att 6_Email reminder for Registration Form.docx
Email reminder_Registration Form (completion)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Registration Form
Agency IC Tracking Number:
0920-21EL
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
0920-
National Learning Community for HIV CBO Leadership Registration Form
Att 4_Registration Form.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
09-20-0161 Records of Health Professionals in Disease Prevention and Control Training Programs
FR Citation:
83 FR 6591
Number of Respondents:
270
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
270
0
270
0
0
0
Annual IC Time Burden (Hours)
14
0
14
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screenshots of National Learning Community for HIV CBO Leadership Registration Form
Att 5_Screenshots of Registration Form.docx
11/03/2021
Email reminder_Registration Form (completion)
Att 6_Email reminder for Registration Form.docx
11/03/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.