Information Collection

HIV-negative MSM Screener-Spanish

IC 219087 under ICR 201511-0920-012 · OMB 0920-1111.

Documents and Forms

Document Name Document Type
Form 0920-15AGK HIV-negative MSM Screener-Spanish Form and Instruction
0920-15AGK Att 3b HIV-Neg MSM Screener_Spanish Att 3b HIV-Neg MSM Screener_Spanish.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIV-negative MSM Screener-Spanish	Agency IC Tracking Number:	15AGK

Is this a Common Form? No		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	0920-15AGK	Att 3b HIV-Neg MSM Screener_Spanish	Att 3b HIV-Neg MSM Screener_Spanish.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.