Standard Structured Interview

Surveillance of HIV/AIDS Related Events Among Persons Not Receiving Care ("Never In Care")

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0748 can be found here:

Documents and Forms

Document Name Document Type
Standard Structured Interview Form and Instruction
Standard Structured Questionnaire for Never In Care Proj Attachment 2a Structured Questionnaire.doc Form and Instruction
Attachment 3 Interview Guide.doc 2007 Interview Guide for Never In Care Project IC Document
Attachment 5a IC for Structured Interview.doc Consent Form for Structured Interview IC Document
Attachment 2c Non-Response Form.doc Non-Response Data Collection Form IC Document

Information Collection (IC) Details

IC Title:	Standard Structured Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	None	Standard Structured Questionnaire for Never In Care Project	Attachment 2a Structured Questionnaire.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2007 Interview Guide for Never In Care Project	Attachment 3 Interview Guide.doc	05/21/2007
Consent Form for Structured Interview	Attachment 5a IC for Structured Interview.doc	05/21/2007
Non-Response Data Collection Form	Attachment 2c Non-Response Form.doc	05/21/2007

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