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Quarterly Assessment
[NCHHSTP] Understanding HIV/STD Risk and Enhancing PrEP Implementation Messaging in a Diverse Community-Based Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in a Transformational Era
OMB: 0920-1421
IC ID: 262651
OMB.report
HHS/CDC
OMB 0920-1421
ICR 202403-0920-004
IC 262651
( )
Documents and Forms
Document Name
Document Type
Form 0920-24DF
Quarterly Assessment
Form
0920-24DF Quarterly assessment English
Att 4c_Quarterly assessment English.docx
Form
0920-24DF Quarterly assessment English
Att 4c_Quarterly assessment English_clean 6 4 2024.docx
Form
0920-24DF Quarterly assessment Spanish
Att 4c_Quarterly assessment Spanish.docx
Form
0920-24DF Quarterly assessment Spanish
Att 4c_Quarterly assessment Spanish_clean 6 4 2024.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Quarterly Assessment
Agency IC Tracking Number:
0920-24DF
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
0920-24DF
Quarterly assessment English
Att 4c_Quarterly assessment English_clean 6 4 2024.docx
Yes
Yes
Fillable Fileable
Form
0920-24DF
Quarterly assessment Spanish
Att 4c_Quarterly assessment Spanish_clean 6 4 2024.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
850
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
3,400
0
0
0
0
3,400
Annual IC Time Burden (Hours)
2,550
0
0
0
0
2,550
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.