Information Collection

Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community

IC 220844 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att1_Screener.docx	Other-WORD
Att3_Focus Group ModeratorGuide.docx	Other-WORD
Att2_SpanishSexualHealthGuide.pdf Att 2_Spanish Sexual Health Guide	IC Document
Att4_EnglishSexualHealthGuide.pdf Att 4_English Sexual Health Guide	IC Document
Project Overview.docx Program Overview	IC Document
Template_Screener.docx Request for Approval - Screener	IC Document
Template_FocusGroup.docx Request for Approval - Focus Group	IC Document
Att5_EngSpanDiscussionGuide.docx Att 5_ English Spanish Discussion Guide	IC Document
Att6_ComparisonEngSpanGuide.docx Att 6_Compairson English/Spanish Guide	IC Document

IC Title:

Take Charge of Your Sexual Health: What you need to know about preventive services: Pre-Testing Hispanic Community

Agency IC Tracking Number:

16WA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att1_Screener.docx		No		Fillable Fileable
Other-WORD			Att3_Focus Group ModeratorGuide.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 2_Spanish Sexual Health Guide	Att2_SpanishSexualHealthGuide.pdf	04/13/2016
Att 4_English Sexual Health Guide	Att4_EnglishSexualHealthGuide.pdf	04/13/2016
Program Overview	Project Overview.docx	04/13/2016
Request for Approval - Screener	Template_Screener.docx	04/13/2016
Request for Approval - Focus Group	Template_FocusGroup.docx	04/13/2016
Att 5_ English Spanish Discussion Guide	Att5_EngSpanDiscussionGuide.docx	04/13/2016
Att 6_Compairson English/Spanish Guide	Att6_ComparisonEngSpanGuide.docx	04/13/2016

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