Client Satisfaction Survey

Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles

Documents and Forms

Document Name Document Type
Client Satisfaction Survey Form
Client Satisfaction Survey Att 3f_Client Satisfaction Survey.docx Form

Information Collection (IC) Details

IC Title:	Client Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Client Satisfaction Survey	Att 3f_Client Satisfaction Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	90	-582	672
Annual IC Time Burden (Hours)	8	-48	56
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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