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

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

Documents and Forms

Document Name Document Type
Aim 2a Cohort Follow Up Survey (English/Spanish) Form and Instruction
Aim2a Cohort Follow-up Survey English Att 4k_Aim2a Cohort Follow Up Survey_English_Clean.docx Form and Instruction
Aim2a Cohort Follow-up Survey Spanish Att 4k_Aim2a Cohort Follow Up Survey_Spanish_Clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Aim 2a Cohort Follow Up Survey (English/Spanish)	Agency IC Tracking Number:	0920-26-0025

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	n/a	Aim2a Cohort Follow-up Survey English	Att 4k_Aim2a Cohort Follow Up Survey_English_Clean.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Aim2a Cohort Follow-up Survey Spanish	Att 4k_Aim2a Cohort Follow Up Survey_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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	402	268	134
Annual IC Time Burden (Hours)	302	0	302
Annual IC Cost Burden (Dollars)	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.