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Health Department Needs Assessment
"HIV Prevention Capacity Development Needs Assessments of Federally funded Health Departments and Community-based Organizations
OMB: 0920-1377
IC ID: 251349
OMB.report
HHS/CDC
OMB 0920-1377
ICR 202201-0920-008
IC 251349
( )
Documents and Forms
Document Name
Document Type
Form 0920-
Health Department Needs Assessment
Form and Instruction
0920- Health Departments Needs Assessment
Att 3b_Health Departments Needs Assessment.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Department Needs Assessment
Agency IC Tracking Number:
0920-21HU
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
0920-
Health Departments Needs Assessment
Att 3b_Health Departments Needs Assessment.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
70
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
70
0
70
0
0
0
Annual IC Time Burden (Hours)
23
0
23
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.