Information Collection

State and Health Dept. CBO Recruitment Flyer- English and Spanish

IC 219085 under ICR 201511-0920-012 · OMB 0920-1111.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 6a HIV-Neg MSM Recruitment Ads_English.docx	Instruction
Att 6b HIV-Neg MSM Recruitment Ads_Spanish.docx	Instruction
Att 6c HIV-negative MSM Recruitment Flyers-English.pdf	Instruction
Att 6d HIV-negative MSM Recruitment Flyers-Spanish.pdf	Instruction

IC Title:

Agency IC Tracking Number:

15AGK

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	Att 6a HIV-Neg MSM Recruitment Ads_English.docx	No	Fillable Printable
Instruction	Att 6b HIV-Neg MSM Recruitment Ads_Spanish.docx	No	Fillable Printable
Instruction	Att 6c HIV-negative MSM Recruitment Flyers-English.pdf	No	Fillable Printable
Instruction	Att 6d HIV-negative MSM Recruitment Flyers-Spanish.pdf	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.