Information Collection

National TB Lab Services Survey and Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation

IC 192789 under ICR 200910-0920-004 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
National TB Lab Services Survey and Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation Form
National TB Lab Services Survey APHL TB Survey _ Beta Test.pdf Form
Assessment of QDS System-screener V-PS_0920-0840_Attachment 3_Screener Form.docx Form
Assessment of QDS System - survey V-PS_0920-0840_Attachment 1_QDS Survey.docx Form
V-PS Lab Survey SSPartA.doc National TB Laboratory Services Survey - supporting statement A IC Document
V-PS_MycolabsurveyPart B.docx National TB Lab Services Survey - supporting statement B IC Document
V-PS_Att 2 Invitation.doc National TB Lab Services Survey - letter of invitation IC Document
V-PS-projectdetermMycolabsurveyAtt 3.pdf National TB Lab Services Survey - nonresearch determination IC Document
RVSD_0920-0840_ QDS Data Collection System_Section A (2).docx Assessment of QDS System - supporting statement A IC Document
V-PS_0920-0840subcollPartB.docx Assessment of QDS System - supporting statement B IC Document
Revsd_0920-0840_Attachment 2_Consent Forms (3).docx Assessment of QDS System - consent forms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National TB Lab Services Survey and Assessment of a QDS Data Collection System in HIV Prevention Program Evaluation	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	National TB Lab Services Survey	APHL TB Survey _ Beta Test.pdf	Yes	Yes	Fillable Fileable
Form	none	Assessment of QDS System-screener	V-PS_0920-0840_Attachment 3_Screener Form.docx	Yes	Yes	Fillable Fileable
Form	none	Assessment of QDS System - survey	V-PS_0920-0840_Attachment 1_QDS Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,308	Number of Respondents for Small Entity: 1,441

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	3,308	0	0	0	0	0
Annual IC Time Burden (Hours)	2,001	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
National TB Laboratory Services Survey - supporting statement A	V-PS Lab Survey SSPartA.doc	04/21/2010
National TB Lab Services Survey - supporting statement B	V-PS_MycolabsurveyPart B.docx	04/21/2010
National TB Lab Services Survey - letter of invitation	V-PS_Att 2 Invitation.doc	04/21/2010
National TB Lab Services Survey - nonresearch determination	V-PS-projectdetermMycolabsurveyAtt 3.pdf	04/21/2010
Assessment of QDS System - supporting statement A	RVSD_0920-0840_ QDS Data Collection System_Section A (2).docx	04/21/2010
Assessment of QDS System - supporting statement B	V-PS_0920-0840subcollPartB.docx	04/21/2010
Assessment of QDS System - consent forms	Revsd_0920-0840_Attachment 2_Consent Forms (3).docx	04/21/2010

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