Aim 2a Cohort Follow Up Survey (English/Spanish)

[NCHHSTP] Expanding PrEP in Communities of Color (EPICC)

Documents and Forms

Document Name Document Type
Form MOD00003217 Aim 2a Cohort Follow Up Survey (English/Spanish) Form and Instruction
MOD00003217 Aim 2a Cohort Follow Up Survey English Att 4k_Aim2aCohortFollowUpSurveyEnglish CLEAN.docx Form and Instruction
MOD00003217 Aim 2a Cohort Follow Up Survey English Att 4k_Aim2aCohortFollowUpSurveyEnglish CLEAN.docx Form and Instruction
0920-1423-24BY Encuesta de seguimiento de cohortes (Aim2aCohortFollowUp Att 4k.a_Aim2aCohortFollowUpSurveySpanish CLEAN.docx Form and Instruction
0920-1423-24BY Encuesta de seguimiento de cohortes (Aim2aCohortFollowUp Att 4k.a_Aim2aCohortFollowUpSurveySpanish CLEAN.docx Form and Instruction
0920-1423 Att 4k - Aim2a Cohort Follow-up Survey English_REV 19SEP Att 4k_FollowUpSurvey_English_clean.docx Form and Instruction
0920-1423 Att 4k - Aim2a Cohort Follow-up Survey English_REV 19SEP Att 4k_FollowUpSurvey_English_clean.docx Form and Instruction
0920-1423 Att 4k - Aim2a Cohort Follow-up Survey Spanish_REV 19SEP Att 4k_FollowUpSurvey_Spanish_clean.docx Form and Instruction
0920-1423 Att 4k - Aim2a Cohort Follow-up Survey Spanish_REV 19SEP Att 4k_FollowUpSurvey_Spanish_clean.docx Form and Instruction
Att 4k.1_Aim2aCohortFollowUpSurveyEnglish(TC).docx Att 4k.1_Aim 2a Cohort Follow-UP Survey (TC) IC Document
Att 4k.1_Aim2aCohortFollowUpSurveyEnglish(TC).docx Att 4k.1_Aim 2a Cohort Follow-UP Survey (TC) IC Document

Information Collection (IC) Details

IC Title:	Aim 2a Cohort Follow Up Survey (English/Spanish)	Agency IC Tracking Number:	0920-1423-24BY

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 and Instruction	MOD00003217	Aim 2a Cohort Follow Up Survey English	Att 4k_Aim2aCohortFollowUpSurveyEnglish CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1423-24BY	Encuesta de seguimiento de cohortes (Aim2aCohortFollowUpSurveySpanish)	Att 4k.a_Aim2aCohortFollowUpSurveySpanish CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1423	Att 4k - Aim2a Cohort Follow-up Survey English_REV 19SEP2025	Att 4k_FollowUpSurvey_English_clean.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1423	Att 4k - Aim2a Cohort Follow-up Survey Spanish_REV 19SEP2025	Att 4k_FollowUpSurvey_Spanish_clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 134	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	134	134
Annual IC Time Burden (Hours)	302	302
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4k.1_Aim 2a Cohort Follow-UP Survey (TC)	Att 4k.1_Aim2aCohortFollowUpSurveyEnglish(TC).docx	01/05/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.