Information Collection

HIV Practice Survey

IC 200546 under ICR 201112-0915-006 · OMB 0915-0349.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HIV Practice Survey	Form and Instruction
Info_Brochure_Practice_Survey.pdf	Instruction
Study_Design_Report.pdf	Other-Study_Design_Report
1 HIV_Practice_Survey HIV_Practice_Survey.pdf	Form and Instruction
2 Pre_and_post_test Post-Pretest-Version-Questionnaire_Practice-Survey.pdf	Form and Instruction

IC Title:

HIV Practice Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	HIV_Practice_Survey	HIV_Practice_Survey.pdf	Yes	Yes	Fillable Fileable
Instruction			Info_Brochure_Practice_Survey.pdf	Yes	No	Printable Only
Form and Instruction	2	Pre_and_post_test	Post-Pretest-Version-Questionnaire_Practice-Survey.pdf	Yes	Yes	Fillable Fileable
Other-Study_Design_Report			Study_Design_Report.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

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	350	350
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	9,517	9,517

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.