Information Collection

Exploratory HIV Testing In-Depth Interview (IDI) Guide

IC 203847 under ICR 201303-0920-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 2b Exploratory-HIV Testing.docx	Other-WORD
Att 3a Consent Form-Exploratory IDI FG.docx Att 3a Consent Form-Exploratory IDI FG	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

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
Other-WORD			Att 2b Exploratory-HIV Testing.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 74

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	74	74
Annual IC Time Burden (Hours)	74	74
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3a Consent Form-Exploratory IDI FG	Att 3a Consent Form-Exploratory IDI FG.docx	03/06/2013

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