OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Local Needs Assessment of Program Collaboration and Service Integration Among Infectious Disease Prevention Providers for Persons Who Use Drugs Illicitly

IC 201871 under ICR 200910-0920-004 · OMB 0920-0840.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Local Needs Assessment of Program Collaboration and Service Integration Among Infectious Disease Prevention Providers for Persons Who Use Drugs Illicitly
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 0405Att_1a_StudyScreener.docx Yes Yes Printable Only
Instruction Att_2a_ConsentFormQuestionnaire.doc Yes Yes Printable Only
Instruction 0405Att_1c_InterviewGuide-2[1].docx No   Printable Only
Instruction 0405Att_1b_InterviewGuide-1[1].doc No   Printable Only

Health Public Health Monitoring

 

300 0
   
Individuals or Households
 
   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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 156 0 156 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A OMB_Sect A_SuppStatement_Jones .docx 04/05/2012
Supporting Statement B OMB_Sect B_SuppStatement.docx 04/05/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.