Internet Partner Service Activities and Guidelines for HIV Testing at Refugee Screening

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

OMB: 0920-0879

IC ID: 210377

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Internet Partner Service Activities and Guidelines for HIV Testing at Refugee Screening Form
ISP PM Data Collection IPS_Att. A_PM Data Collection Instrument.docx Form
ISP Assessment IPS_Att. C- DIS IPS Assessment_Web version.docx Form
Assessment of Guidelines for HIV Testing in Refugees HIV_Att C_Data Collection Instrument_Web version.docx Form
IPS_Att E_Email notification for DIS IPS Assessment.docx IPS Email for DIS ISP IC Document
IPS_Att. F_Day 5 Reminder email to DIS.docx ISP DIS Day 5 Reminder IC Document
IPS_Att. G_Day 10 reminder email to DIS.docx IPS DIS 10 Day Reminder IC Document
IPS_Att. B_DIS IPS Assessment.docx ISP DIS Assessment Word Version IC Document
IPS_Att. D_ PM Follow Up Email.docx ISP PM Follow-up Reminder IC Document
HIV- Supporting_Statement_B.docx HIV - Supporting Statement B IC Document
HIV_Att. A- Refugee HIV Screening Exam.pdf HIV - Att A - Refugee Screening Exam Keypoints IC Document
HIV_Att B_Data Collection Instrument.docx HIV - Att B - Assessment - Word IC Document
HIV_Att. D-Notification Email.docx HIV - Att D - Email Notification IC Document
HIV_Att. E -Reminder Email.docx HIV - Att E - Reminder Email IC Document
HIV_Att. F-FINAL Reminder Email.docx HIV - Att F - Reminder Email IC Document
HIV_Att. G-Follow up Email.docx HIV - Att G - Follow-up Email IC Document
HIV- Supporting_Statement_A.docx 2 10 14.docx HIV - Supporting Statement A IC Document
IPS_Supporting Statement B.docx ISP Supporting Statement Part B IC Document
IPS_Supporting Statement A.docx ISP Supporting Statement Part A IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Internet Partner Service Activities and Guidelines for HIV Testing at Refugee Screening	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	ISP PM Data Collection	IPS_Att. A_PM Data Collection Instrument.docx	No	No	Fillable Fileable
Form	none	ISP Assessment	IPS_Att. C- DIS IPS Assessment_Web version.docx	Yes	Yes	Fillable Fileable
Form	none	Assessment of Guidelines for HIV Testing in Refugees	HIV_Att C_Data Collection Instrument_Web version.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 925	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	925	0	0	0	0	0
Annual IC Time Burden (Hours)	372	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
IPS Email for DIS ISP	IPS_Att E_Email notification for DIS IPS Assessment.docx	02/06/2014
ISP DIS Day 5 Reminder	IPS_Att. F_Day 5 Reminder email to DIS.docx	02/06/2014
IPS DIS 10 Day Reminder	IPS_Att. G_Day 10 reminder email to DIS.docx	02/06/2014
ISP DIS Assessment Word Version	IPS_Att. B_DIS IPS Assessment.docx	02/07/2014
ISP PM Follow-up Reminder	IPS_Att. D_ PM Follow Up Email.docx	02/07/2014
HIV - Supporting Statement B	HIV- Supporting_Statement_B.docx	02/10/2014
HIV - Att A - Refugee Screening Exam Keypoints	HIV_Att. A- Refugee HIV Screening Exam.pdf	02/10/2014
HIV - Att B - Assessment - Word	HIV_Att B_Data Collection Instrument.docx	02/10/2014
HIV - Att D - Email Notification	HIV_Att. D-Notification Email.docx	02/10/2014
HIV - Att E - Reminder Email	HIV_Att. E -Reminder Email.docx	02/10/2014
HIV - Att F - Reminder Email	HIV_Att. F-FINAL Reminder Email.docx	02/10/2014
HIV - Att G - Follow-up Email	HIV_Att. G-Follow up Email.docx	02/10/2014
HIV - Supporting Statement A	HIV- Supporting_Statement_A.docx 2 10 14.docx	02/10/2014
ISP Supporting Statement Part B	IPS_Supporting Statement B.docx	02/10/2014
ISP Supporting Statement Part A	IPS_Supporting Statement A.docx	02/10/2014

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