Counseling, Testing and Referral for Community-Based Organizations

HIV Prevention Program Evaluation and Monitoring System for Health Departments and Community-Based Organizations (PEMS)

OMB: 0920-0696

IC ID: 180696

Information Collection (IC) Details

View Information Collection (IC)

Counseling, Testing and Referral for Community-Based Organizations
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Counseling, Testing and Referral Form Attachment E. Part 1 CTR HIV Testing Form.pdf Yes Yes Fillable Printable
Form and Instruction None Reverse Side of CTR Form with Codes Attachment E. Part 2 CTR HIV Testing Form Codes.pdf Yes Yes Fillable Printable
Form and Instruction No name HIV Test Form 1 new version HIV Test Form_Part 1 & 2 (NEW) (OMB).pdf Yes No Fillable Printable

Health Public Health Monitoring

 

70 70
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 280 0 0 0 0 280
Annual IC Time Burden (Hours) 6,440 0 0 0 0 6,440
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy