Information Collection

"Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV)" - Pharmacy Staff Baseline Survey (Pharmacist)

IC 190720 under ICR 200909-0920-010 · OMB 0920-0837.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
09AF_Att3a_Pharmacy Staff Baseline Survey.doc	Other-WORD
09AF_Att4a_Pharmacist Consent.doc 09AF_Att4a_Pharmacist Consent	IC Document
09AF_Att4b_Pharmacy Staff Consent 0920-09XX.doc 09AF_Att4b_Pharmacy Staff Consent 0920-09XX	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

"Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (Pharm-HIV)" - Pharmacy Staff Baseline Survey (Pharmacist)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			09AF_Att3a_Pharmacy Staff Baseline Survey.doc		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 48

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
09AF_Att4a_Pharmacist Consent	09AF_Att4a_Pharmacist Consent.doc	09/04/2009
09AF_Att4b_Pharmacy Staff Consent 0920-09XX	09AF_Att4b_Pharmacy Staff Consent 0920-09XX.doc	09/04/2009

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