NHBS Screening (All Respondent Groups)

[NCHHSTP] National HIV Behavioral Surveillance System

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 (English) Att 3a_Eligibility Screener_Eng.docx Form and Instruction
0920-0770 Eligibility Screener (Spanish) Att 4a_Eligibility Screener_Span.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: 12,500	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	12,500	-2,500	15,000
Annual IC Time Burden (Hours)	1,042	-208	1,250
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.