Screening for climate survey round 2

Midwest HIV Prevention and Pregnancy Planning Initiative (MHPPPI)

OMB: 0990-0439

IC ID: 218818

Documents and Forms
Document Name
Document Type
Other-Provider
Information Collection (IC) Details

View Information Collection (IC)

Screening for climate survey round 2
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Provider 0990-MHPPPI-provider eligibility screener.docx No   Fillable Printable

Health Health Care Services

 

800 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   80 %

  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 800 0 800 0 0 0
Annual IC Time Burden (Hours) 13 0 13 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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