Follow-up Assessment -- UNCG

HIV/AIDS Risk Reduction Interventions for African-American Heterosexual Men

Documents and Forms

Document Name Document Type
0920-10CM_Att3i_BL and FU Assessments (UNCG).doc Other-WORD
0920-10CM_Att3i_BL and FU Assessments UNCG 11[1].15.2010-clean.docx Other-WORD

Information Collection (IC) Details

IC Title:	Follow-up Assessment -- UNCG	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
Other-WORD			0920-10CM_Att3i_BL and FU Assessments (UNCG).doc		Yes	Yes	Fillable Printable
Other-WORD			0920-10CM_Att3i_BL and FU Assessments UNCG 11[1].15.2010-clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	27	27
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.