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.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0405Att_1a_StudyScreener.docx	Instruction
Att_2a_ConsentFormQuestionnaire.doc	Instruction
0405Att_1b_InterviewGuide-1[1].doc	Instruction
0405Att_1c_InterviewGuide-2[1].docx	Instruction
OMB_Sect A_SuppStatement_Jones .docx Supporting Statement A	IC Document
OMB_Sect B_SuppStatement.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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

Documents for IC

table that charts IC Documents
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.