Information Collection

HIV Clinician Survey

IC 200545 under ICR 201112-0915-006 · OMB 0915-0349.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Pretest HIV Clinician Survey	Form and Instruction
Form 1 Clinician survey HIV Clinician Survey	Form and Instruction
Info_Brochure_Clinician_Survey.pdf	Instruction
Web_Example.pdf	Other-Web_Demo
Study_Design_Report.pdf	Other-Study Design Report
2 Pretest Pretest-Version-Questionnaire_Clinician-Survey.pdf	Form and Instruction
1 Clinician survey HIV Clinician Workforce Study - Final Design Report (To HRSA).docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Printable Only
Form and Instruction	2	Yes	Yes	Fillable Fileable
Other-Web_Demo		Yes	No	Printable Only
Other-Study Design Report		Yes	No	Printable Only
Form and Instruction	1	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

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	3,500	3,500
Annual IC Time Burden (Hours)	1,155	1,155
Annual IC Cost Burden (Dollars)	96,546	96,546

Documents for IC

table that charts IC Documents
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.

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