Information Collection Request

Evaluation of the Get Yourself Tested (GYT) Campaign

ICR 201212-0920-006 · OMB 0920-0957 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
GYT: Get Yourself Tested Form New Available
Part B_comments_rk edits 2-20-13.docx Supporting Statement B Uploaded 2013-02-26 Available
Attach 7 Sample e-mail reminder.docx Supplementary Document Uploaded 2012-12-17 Available
Attach 5 KnowledgeNetworksInformation.docx Supplementary Document Uploaded 2012-12-17 Available
Attach 4 Sample Email Invitation_rk edit.docx Supplementary Document Uploaded 2012-12-17 Available
Attach 3 Consent Forms.docx Supplementary Document Uploaded 2013-02-26 Available
Attach 2 60day-FRN Published.pdf Supplementary Document Uploaded 2012-12-17 Available
Attach 1 Sect 301 PHSA.pdf Supplementary Document Uploaded 2012-12-17 Available
Attach 8 Screen Shots-Survey.docx Supplementary Document Uploaded 2012-12-17 Repair queued
Part A_comments-2-20-13.docx Supporting Statement A Uploaded 2013-02-26 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
205171 GYT: Get Yourself Tested Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
4,000 0 0
2,000 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
GYT: Get Yourself Tested none GYT: Get Yourself Tested Instrument

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,000 0 0 4,000 0 0
Annual Time Burden (Hours) 2,000 0 0 2,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No