In-depth Interview Consent

Evaluation of Free Rapid HIV at-home Testing

OMB: 0920-1018

IC ID: 211018

Information Collection (IC) Details

View Information Collection (IC)

In-depth Interview Consent
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Consent Consent_screenshot.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

30 0
   
Individuals or Households
 
   100 %

  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 30 0 30 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Interview Consent Word Version Att 4c In-depth Interview consent.docx 03/27/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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