Information Collection

CBO Needs Assessment for Preparedness and Resources for Support of Biomedical HIV Prevention

IC 206398 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 5 Pre-test Telephone Interview Script.docx	Other-Pre-test Telephone Interview S
Biomedical HIV Prevention Organizational Assessment Web- Att 9b Biomed HIV Prev Org Assessment-screenshots.docx	Form
Consent Form Att 8 Consent Form.docx	Form
Att 6 Survey Telephone Recruitment Script.docx Att 6 Survey Telephone Recruitment Script	IC Document
Att 3 Pre-test Tele Recruitment Script.docx Att 3 Pre-test Tele Recruitment Script	IC Document
Att 4 Pre-test Recruitment Email.docx Att 4 Pre-test Recruitment Email	IC Document
SSA.docx SSA	IC Document
Att 7 Survey Email Recruitment Script.docx Att 7 Survey Email Recruitment Script	IC Document
Att 9a Biomed HIV Prev Org Assessment.docx Att 9a Biomed HIV Prev Org Assessment	IC Document
SSB.doc SSB	IC Document

IC Title:

CBO Needs Assessment for Preparedness and Resources for Support of Biomedical HIV Prevention

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pre-test Telephone Interview Script			Att 5 Pre-test Telephone Interview Script.docx	Yes	No	Paper Only
Form	None	Biomedical HIV Prevention Organizational Assessment Web-based Survey Screenshots	Att 9b Biomed HIV Prev Org Assessment-screenshots.docx	Yes	Yes	Fillable Fileable
Form	none	Consent Form	Att 8 Consent Form.docx	Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 895

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 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	895	0	0	0	0	0
Annual IC Time Burden (Hours)	323	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 6 Survey Telephone Recruitment Script	Att 6 Survey Telephone Recruitment Script.docx	04/05/2013
Att 3 Pre-test Tele Recruitment Script	Att 3 Pre-test Tele Recruitment Script.docx	04/05/2013
Att 4 Pre-test Recruitment Email	Att 4 Pre-test Recruitment Email.docx	04/05/2013
SSA	SSA.docx	04/05/2013
Att 7 Survey Email Recruitment Script	Att 7 Survey Email Recruitment Script.docx	04/05/2013
Att 9a Biomed HIV Prev Org Assessment	Att 9a Biomed HIV Prev Org Assessment.docx	04/05/2013
SSB	SSB.doc	04/05/2013

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