Aims 1&2 Clinic Assessment (every 6 months)

[NCHHSTP] _Expanding PrEP in Communities of Color (EPICC) (24BY)

Documents and Forms

Document Name Document Type
Form 0920-22GA Aims 1&2 Clinic Assessment (every 6 months) Form and Instruction
0920-22GA Aims 1&2 Clinic Assessment (every 6 months) Att_4s_Aim1&2ClinicAssessmentEvery6Months[1].docx Form and Instruction
0920-22GA Aims 1&2 Clinic Assessment (every 6 months) Att_4s_Aim1&2ClinicAssessmentEvery6Months[1].docx Form and Instruction

Information Collection (IC) Details

IC Title:	Aims 1&2 Clinic Assessment (every 6 months)	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	Aims 1&2 Clinic Assessment (every 6 months)	Att_4s_Aim1&2ClinicAssessmentEvery6Months[1].docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	Previously Approved
Annual Number of Responses for this IC	9	9
Annual IC Time Burden (Hours)	27	27
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.