Reporting of Test Results (during study)

Evaluation of Free Rapid HIV at-home Testing

Documents and Forms

Document Name Document Type
Reporting of Test Results (during study) Form and Instruction
Reporting Home Test Results Reporting of Home Test Results_Screenshot.docx Form and Instruction
Att 3e Reporting of Self-Test Results.docx Reporting Self Test IC Document

Information Collection (IC) Details

IC Title:	Reporting of Test Results (during study)	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
Form and Instruction	none	Reporting Home Test Results	Reporting of Home Test Results_Screenshot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	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	4,800	4,800
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Reporting Self Test	Att 3e Reporting of Self-Test Results.docx	03/27/2014

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