Intervention Trials- Contact/Locator Information

Intervention Trials To Retain HIV-Positive Patients in Medical Care

Documents and Forms

Document Name Document Type
Form Tab 10 Intervention Trials- Contact/Locator Information Form and Instruction
Tab 10 Contact/Location Information Form Tab 10 Contact Locator Info Form.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Intervention Trials- Contact/Locator Information	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	Tab 10	Contact/Location Information Form	Tab 10 Contact Locator Info Form.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,800	4,800
Annual IC Time Burden (Hours)	398	398
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.