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Federal forms, ICRs, and supporting documents

Information Collection

Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Syringe Transaction and Referral Log (Pharmacy Technicians)

IC 190723 under ICR 200909-0920-010 · OMB 0920-0837.

Documents and Forms
Document Name
Document Type
Other-WORD
IC Document
IC Document
Information Collection (IC) Details

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Evaluation of Pharmacy Syringe Access Linked to HIV Testing for Injection Drug Users in New York City (PHarm-HIV) Syringe Transaction and Referral Log (Pharmacy Technicians)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD 09AF_Att3d_Pharmacy Staff Six Monthly Survey.doc No No Fillable Printable

Health Illness Prevention

 

48 48
   
Private Sector Businesses or other for-profits
 
   0 %

  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 96 0 96 0 0 0
Annual IC Time Burden (Hours) 32 0 32 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
09AF_Att4c_Syringe Customer Participant Referral Consent 09AF_Att4c_Syringe Customer Participant Referral Consent.doc 09/04/2009
09AF_Att4d_Syringe Customer Participant In-Pharmacy Testing Consent 09AF_Att4d_Syringe Customer Participant In-Pharmacy Testing Consent.doc 09/04/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.