ACASI Questionnaire

The effectiveness of donor notification, HIV, counseling, and linkage of HIV positive donors to health care in Brazil

Documents and Forms

Document Name Document Type
Form 2 ACASI Questionnaire Form and Instruction
2 Attachment 1 ACASI Questionnaire English Attach_1_ACASI_Questionnaire_English_9_2014_V_3.0-1.docx Form and Instruction
4 Attachment 5 ACASI Questionnaire Portuguese Attach_5_ACASI_Questionnaire_Portuguese_10_14_V_2.0.docx Form and Instruction

Information Collection (IC) Details

IC Title:	ACASI Questionnaire	Agency IC Tracking Number:

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	2	Attachment 1 ACASI Questionnaire English	Attach_1_ACASI_Questionnaire_English_9_2014_V_3.0-1.docx		Yes	Yes	Fillable Fileable
Form and Instruction	4	Attachment 5 ACASI Questionnaire Portuguese	Attach_5_ACASI_Questionnaire_Portuguese_10_14_V_2.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	275	275
Annual IC Time Burden (Hours)	183	183
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.