Information Collection

HIV Partner Services Material Testing Interview

IC 183185 under ICR 201104-0920-002 · OMB 0920-0775.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HIV Partner Services Material Testing Interview	Form
Partner Services - Material Testing Interview A2d Data Collection Instruments-Partner Services-materials.docx	Form
A5c_Consent Forms-PS_3-1-11.doc Consent for Partner Services Interview	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	none	Partner Services - Material Testing Interview	A2d Data Collection Instruments-Partner Services-materials.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

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	Previously Approved
Annual Number of Responses for this IC	13	-7	20
Annual IC Time Burden (Hours)	13	-7	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent for Partner Services Interview	A5c_Consent Forms-PS_3-1-11.doc	03/23/2011

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