Community-Based Organization HIV Prevention Survey

Community-Based Organizations’ Changes in Preparedness and Resources for Support of Biomedical HIV Prevention

Documents and Forms

Document Name Document Type
Community-Based Organization HIV Prevention Survey Form and Instruction
CBO HIV Prevention Survey Att 5a_CBO Survey Instrument_10172022_clean.docx Form and Instruction
CBO HIV Prevention Survey Att 5a_CBO Survey Instrument_10172022_clean.docx Form and Instruction
Att 5b_Survey Instrument.pdf CBO HIV Prevention Survey Screenshots IC Document
Att 5b_Survey Instrument.pdf CBO HIV Prevention Survey Screenshots IC Document
Att 5a_CBO Survey Instrument_10172022_tracked.docx Survey with Oct 2022 Monkeypox questions in tracked-changes IC Document
Att 5a_CBO Survey Instrument_10172022_tracked.docx Survey with Oct 2022 Monkeypox questions in tracked-changes IC Document

Information Collection (IC) Details

IC Title:	Community-Based Organization HIV Prevention Survey	Agency IC Tracking Number:	0920-20HR

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	None	CBO HIV Prevention Survey	Att 5a_CBO Survey Instrument_10172022_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 330	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	330	0	330
Annual IC Time Burden (Hours)	193	28	165
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
CBO HIV Prevention Survey Screenshots	Att 5b_Survey Instrument.pdf	08/25/2020
Survey with Oct 2022 Monkeypox questions in tracked-changes	Att 5a_CBO Survey Instrument_10172022_tracked.docx	10/17/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.