Intensive Complete Long-Term Evaluation

[NCHHSTP] National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC)

Documents and Forms

Document Name Document Type
Intensive Complete Long-Term Evaluation Form and Instruction
Intensive Complete Long-Term Evaluation (paper option) Att 15_Intensive-Long Term Evaluation-2022- 11.22.22.docx Form and Instruction
Intensive Complete Long-Term Evaluation (paper option) Att 15_Intensive-Long Term Evaluation-2022- 11.22.22.docx Form and Instruction
Intensive Complete Long-Term Evaluation (electronic opti Att 16_ Intensive Long-Term Evaluation 2022- Screenshot.pdf Form and Instruction
Intensive Complete Long-Term Evaluation (electronic opti Att 16_ Intensive Long-Term Evaluation 2022- Screenshot.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Intensive Complete Long-Term Evaluation	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	None	Intensive Complete Long-Term Evaluation (paper option)	Att 15_Intensive-Long Term Evaluation-2022- 11.22.22.docx		No		Paper Only
Form and Instruction	None	Intensive Complete Long-Term Evaluation (electronic option)	Att 16_ Intensive Long-Term Evaluation 2022- Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.