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Aims 1&2 Clinic Assessment (Baseline & Final)
[NCHHSTP] _Expanding PrEP in Communities of Color (EPICC) (24BY)
OMB: 0920-1423
IC ID: 263136
OMB.report
HHS/CDC
OMB 0920-1423
ICR 202401-0920-004
IC 263136
( )
Documents and Forms
Document Name
Document Type
Form 0920-22GA
Aims 1&2 Clinic Assessment (Baseline & Final)
Form and Instruction
0920-22GA Att 4r_Aim1&2ClinicAssessmentBaselineAndFinal
Att_4r_Aim1&2ClinicAssessmentBaselineAndFinal[1].docx
Form and Instruction
0920-22GA Att 4r_Aim1&2ClinicAssessmentBaselineAndFinal
Att_4r_Aim1&2ClinicAssessmentBaselineAndFinal[1].docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Aims 1&2 Clinic Assessment (Baseline & Final)
Agency IC Tracking Number:
0920-22GA
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
0920-22GA
Att 4r_Aim1&2ClinicAssessmentBaselineAndFinal
Att_4r_Aim1&2ClinicAssessmentBaselineAndFinal[1].docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
9
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
9
0
0
0
0
9
Annual IC Time Burden (Hours)
18
0
0
0
0
18
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.