Information Collection

STD/HIV Disease Intervention Specialist (DIS) Workforce Assessment

IC 221362 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
STD/HIV Disease Intervention Specialist (DIS) Workforce Assessment	Form and Instruction
DIS Enumeration Data Collection Instrument Attachment C Instrument_Web Version-DIS-ENUM.docx	Form and Instruction
Attachment A State Territorial and Local Health Departments-DIS-ENUM.docx State Territorial and Local Health Departments List	IC Document
Attachment D. Notification Email-DIS-ENUM.docx Notification Email	IC Document
Attachment E. Reminder Email-DIS-ENUM.docx Reminder Email	IC Document
Attachment F Extension Email-DIS-ENUM.docx Extension Email	IC Document
Attachment B Instrument_Word Version-DIS-ENUM.docx Instrument - WORD Version	IC Document
DIS-ENUM-SSA 04MAY2016.docx Supporting Statement A	IC Document
DIS-ENUM-SSB.docx Supporting Statement B	IC Document

IC Title:

STD/HIV Disease Intervention Specialist (DIS) Workforce Assessment

Agency IC Tracking Number:

0920-0879-16AFI

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
Form and Instruction	NA	DIS Enumeration Data Collection Instrument	Attachment C Instrument_Web Version-DIS-ENUM.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 499

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	499	499
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
State Territorial and Local Health Departments List	Attachment A State Territorial and Local Health Departments-DIS-ENUM.docx	05/04/2016
Notification Email	Attachment D. Notification Email-DIS-ENUM.docx	05/04/2016
Reminder Email	Attachment E. Reminder Email-DIS-ENUM.docx	05/04/2016
Extension Email	Attachment F Extension Email-DIS-ENUM.docx	05/04/2016
Instrument - WORD Version	Attachment B Instrument_Word Version-DIS-ENUM.docx	05/04/2016
Supporting Statement A	DIS-ENUM-SSA 04MAY2016.docx	05/04/2016
Supporting Statement B	DIS-ENUM-SSB.docx	05/04/2016

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