3-month Assessment

Critical Thinking and Cultural Affirmation: Evaluation of a Locally Developed HIV Prevention Intervention

Documents and Forms

Document Name Document Type
Form Attachment 9 3-month Assessment Form
Attachment 9 3 month follow-up 3-mo Assessment_OMB Comments.7.4.12 revised_clean.docx Form

Information Collection (IC) Details

IC Title:	3-month Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Attachment 9	3 month follow-up	3-mo Assessment_OMB Comments.7.4.12 revised_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 132	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	132	132
Annual IC Time Burden (Hours)	132	132
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.