Eligibility Screener

Evaluation of Free Rapid HIV at-home Testing

OMB: 0920-1018

IC ID: 211027

Information Collection (IC) Details

View Information Collection (IC)

Eligibility Screener
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form form Eligibility Screener Eligibility Screener_screenshot.docx Yes Yes Fillable Fileable

Health Immunization Management

 

24,000 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 24,000 0 24,000 0 0 0
Annual IC Time Burden (Hours) 1,200 0 1,200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Eligibility Screener Att 3a Eligibility Screener.docx 03/27/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy