Information Collection

Safer Sex Intervention Survey

IC 204997 under ICR 201212-0990-001 · OMB 0990-0405.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Safer Sex Intervention Survey	Form and Instruction
1 Safer Sex Intervention Survey TPP Replication Study Follow-Up Survey Attachment D - SSI.docx	Form and Instruction

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Safer Sex Intervention Survey	TPP Replication Study Follow-Up Survey Attachment D - SSI.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: 1,900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,800	3,800
Annual IC Time Burden (Hours)	1,900	1,900
Annual IC Cost Burden (Dollars)	12,398	12,398

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.