Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars Form
1 BF_Webinar_Survey_4_24_2018.docx BF_Webinar_Survey_4_24_2018.docx Form
Supporting_Statement_BF_Webinar_Survey_4_24_2018.docx Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars	Agency IC Tracking Number:

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	1	BF_Webinar_Survey_4_24_2018.docx	BF_Webinar_Survey_4_24_2018.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Supporting_Statement_BF_Webinar_Survey_4_24_2018.docx	07/10/2018

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