STD/HIV Disease Intervention Specialist (DIS) Workforce Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.