Information Collection

HIV Testing and Counseling Baseline & 3-Month Follow-up

IC 194317 under ICR 201008-0920-009 · OMB 0920-0872.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc	Other-Cover Page
Attachment 7a_NYS Informed Consent HIV Testing.pdf	Other-Informed Consent
Attachment 7b_NYS HIV Testing Flowchart.pdf Process Flowchart	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Page			Attachment 7a-Cover-HIV Testing and Counseling Protocol and Consent.doc		Yes	No	Fillable Fileable
Other-Informed Consent			Attachment 7a_NYS Informed Consent HIV Testing.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	400
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Process Flowchart	Attachment 7b_NYS HIV Testing Flowchart.pdf	08/03/2010

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