Electronic Transmittal of Clinical Variables Archived in Clinic Databases--Data Manager/no form

Assessment of a Comprehensive HIV Clinic-based Intervention to Improve Patients' Health and Reduce Transmission Risk

Documents and Forms

Document Name Document Type
App 14 Informed consent forms.docx Other-Records/Data extraction

Information Collection (IC) Details

IC Title:	Electronic Transmittal of Clinical Variables Archived in Clinic Databases--Data Manager/no form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Records/Data extraction			App 14 Informed consent forms.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	576	576
Annual IC Cost Burden (Dollars)	11,667	11,667

Documents for IC

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.