NHBS Screening (All Respondent Groups)

National HIV Behavioral Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0770 NHBS Screening (All Respondent Groups) Form and Instruction
0920-0770 Attachment 3a 0920-0770_Att 3a_Eligibility Screener_Spanish.pdf Form and Instruction
0920-0770 Attachment 2A 0920-0770_Att 2a_Eligibility Screener_Eng.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	NHBS Screening (All Respondent Groups)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	0920-0770	Attachment 3a	0920-0770_Att 3a_Eligibility Screener_Spanish.pdf		Yes	Yes	Fillable Printable
Form and Instruction	0920-0770	Attachment 2A	0920-0770_Att 2a_Eligibility Screener_Eng.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	1,250	1,250
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.