Information Collection

Formative Research and Tool Development: Survey of HIV Medical Care Providers to Guide the Medical Monitoring Project

IC 205959 under ICR 201301-0920-010 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Formative Research and Tool Development: Survey of HIV Medical Care Providers to Guide the Medical Monitoring Project	Form
MMP Provider Survey Att 3_ MMPPS Survey.docx	Form
MMP Provider Survey Web-based Application Screenshots Att 2_MMPPS Screenshots.pdf	Form
Att 4_MMPPS Recruitment Materials.pdf Att 4_MMPPS Recruitment Materials	IC Document
MMPPS SuppStat - A.docx MMPPS SuppStat - A	IC Document
MMPPS SuppStat - B.docx MMPPS SuppStat - B	IC Document
Att 1_MMPPS Sect 301 PHSA.pdf Att 1_MMPPS Sect 301 PHSA	IC Document

IC Title:

Formative Research and Tool Development: Survey of HIV Medical Care Providers to Guide the Medical Monitoring Project

Agency IC Tracking Number:

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	none	MMP Provider Survey	Att 3_ MMPPS Survey.docx		Yes	Yes	Fillable Printable
Form	none	MMP Provider Survey Web-based Application Screenshots	Att 2_MMPPS Screenshots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	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	5,400	0	0	0	0	0
Annual IC Time Burden (Hours)	1,300	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4_MMPPS Recruitment Materials	Att 4_MMPPS Recruitment Materials.pdf	02/26/2013
MMPPS SuppStat - A	MMPPS SuppStat - A.docx	02/26/2013
MMPPS SuppStat - B	MMPPS SuppStat - B.docx	02/26/2013
Att 1_MMPPS Sect 301 PHSA	Att 1_MMPPS Sect 301 PHSA.pdf	02/26/2013

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