Baseline Assessment

Nurse Delivered Risk Reduction Intervention for HIV-Positive Women In the South

Documents and Forms

Document Name Document Type
Form 4 Baseline Assessment Form and Instruction
4 Baseline Assessment Att 5_BaselineFollowupAssessment.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Baseline Assessment	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	4	Baseline Assessment	Att 5_BaselineFollowupAssessment.doc		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 330	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	330	330
Annual IC Time Burden (Hours)	248	248
Annual IC Cost Burden (Dollars)	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.