Technical Assistance provided to Ryan White HIV/AIDS Program Grantees

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Technical Assistance provided to Ryan White HIV/AIDS Program Grantees Form
1 Comprehensive Site Visit Baseline & Follow-up Survey - (Comprehensive Site Visit).pdf Form
2 non-comprehensive site visit Baseline & Follow-up Survey (Non-Comprehensive Site Visit....pdf Form
Email Content Baseline Survey for Comprehensive and Non-....pdf Email Content Baseline Survey for Comprehensive and Non-... IC Document
Email Content for Follow-up Surveys (ABT).pdf Email Content for Follow-up Surveys (ABT) IC Document
Supporting Statement.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Technical Assistance provided to Ryan White HIV/AIDS Program Grantees	Agency IC Tracking Number:

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	1	Comprehensive Site Visit	Baseline & Follow-up Survey - (Comprehensive Site Visit).pdf		Yes	Yes	Fillable Fileable
Form	2	non-comprehensive site visit	Baseline & Follow-up Survey (Non-Comprehensive Site Visit....pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 78	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

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	156	0	0	0	0	0
Annual IC Time Burden (Hours)	26	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Email Content Baseline Survey for Comprehensive and Non-...	Email Content Baseline Survey for Comprehensive and Non-....pdf	07/29/2013
Email Content for Follow-up Surveys (ABT)	Email Content for Follow-up Surveys (ABT).pdf	07/29/2013
Supporting Statement	Supporting Statement.docx	07/29/2013

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