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HIV Testing & Counseling
An assessment of the determinations of HIV risk factors for African American and Hispanic women in the southeastern United States
OMB: 0920-0760
IC ID: 181808
OMB.report
HHS/CDC
OMB 0920-0760
ICR 200708-0920-002
IC 181808
( )
Documents and Forms
Document Name
Document Type
APPENDIX 12 HIV Couns Testing guide.doc
Other-HIV Testing & Counseling
APPENDIX 3-2 survey-testing consent.doc
Survey Testing Consent
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HIV Testing & Counseling
Agency IC Tracking Number:
Is this a Common Form?
Yes
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
Other-HIV Testing & Counseling
APPENDIX 12 HIV Couns Testing guide.doc
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
450
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
450
0
450
0
0
0
Annual IC Time Burden (Hours)
338
0
338
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Survey Testing Consent
APPENDIX 3-2 survey-testing consent.doc
07/23/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.