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Peer Recruiters - Recruiter Debriefing Form
[NCHHSTP] Barriers and Facilitators to Expanding the NHBS to Conduct HIV Behavioral Surveillance Among Transgender Women (NHBS-Trans)
OMB: 0920-1262
IC ID: 234908
OMB.report
HHS/CDC
OMB 0920-1262
ICR 202301-0920-002
IC 234908
( )
Documents and Forms
Document Name
Document Type
Peer Recruiters - Recruiter Debriefing Form
Form and Instruction
Recruiter Debriefing Form (English)
Att 4c_Recruiter Debriefing Form (English).docx
Form and Instruction
Recruiter Debriefing Form (English)
Att 4c_Recruiter Debriefing Form (English).docx
Form and Instruction
Recruiter Debriefing Form (Spanish)
Att 5c_Recruiter Debriefing Form (Spanish).docx
Form and Instruction
Recruiter Debriefing Form (Spanish)
Att 5c_Recruiter Debriefing Form (Spanish).docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Peer Recruiters - Recruiter Debriefing Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Recruiter Debriefing Form (English)
Att 4c_Recruiter Debriefing Form (English).docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Recruiter Debriefing Form (Spanish)
Att 5c_Recruiter Debriefing Form (Spanish).docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
76 FR 4458
Number of Respondents:
1,400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
1,400
0
0
0
0
1,400
Annual IC Time Burden (Hours)
47
0
0
0
0
47
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.