NHBS Recruiter Debriefing

National HIV Behavioral Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0770 can be found here:

Documents and Forms

Document Name Document Type
NHBS Recruiter Debriefing Form and Instruction
Recruiter Debriefing - Spanish Att 3e_Recruiter_Debriefing_Spanish.pdf Form and Instruction
Recruiter Debriefing Att 2e_Recruiter_Debriefing_Eng.pdf Form and Instruction
Att 13_Recruiter training script.docx 13 - Recruiter Training Script IC Document

Information Collection (IC) Details

IC Title:	NHBS Recruiter Debriefing	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	none	Recruiter Debriefing - Spanish	Att 3e_Recruiter_Debriefing_Spanish.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	none	Recruiter Debriefing	Att 2e_Recruiter_Debriefing_Eng.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,167	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,167	4,167
Annual IC Time Burden (Hours)	139	139
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
13 - Recruiter Training Script	Att 13_Recruiter training script.docx	02/24/2014

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