Adherence Participant Feedback Form

Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0195 can be found here:

Documents and Forms

Document Name Document Type
APFF Instructions.pdf Instruction
Adherence Particip Adherence Participant Feedback March 2011 Adherence Fdbk Form 0399_001.pdf Form

Information Collection (IC) Details

IC Title:	Adherence Participant Feedback Form	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
Instruction			APFF Instructions.pdf		Yes	Yes	Paper Only
Form	Adherence Participant Feedback	Adherence Participant Feedback	March 2011 Adherence Fdbk Form 0399_001.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	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.