0920-1357 GAIN Study Visit Survey - Revised 09SEP2022

[NCHHSTP] The GAIN (Greater Access and Impact with NAT) Study: Improving HIV Diagnosis, Linkage to Care, and Prevention Services with HIV Point-of-Care Nucleic Acid Tests (NATs)

Att 11_GAIN study visit survey_screenshots_changes accepted_082922

OMB: 0920-1357

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-1357 can be found here:

2024-11-19 - No material or nonsubstantive change to a currently approved collection

Document [docx]

Download: docx | pdf

Shape1

Form Approved

OMB No. 0920-1357

Expiration Date: 12/31/2024

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1357)

If HIV status negative or unknown:

If HIV status positive:

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Lisa A Niemann
File Modified	0000-00-00
File Created	2023-11-13