Screeners and Survey Questionnaire

Evaluation of NIAID's HIV Vaccine Research Education Initiative Highly Impacted Population Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0618 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Screeners and Survey Questionnaire Form and Instruction
Attachment D_Letter_Scripts_Emails_10_26_09.doc Instruction
1 Survey Attachment C_HIP_Survey_11-18-09.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Screeners and Survey Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey	Attachment C_HIP_Survey_11-18-09.doc		Yes	Yes	Paper Only
Instruction			Attachment D_Letter_Scripts_Emails_10_26_09.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 29 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	1,167	1,167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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