Information Collection

Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing

IC 227197 under ICR 201605-0920-001 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing	Form and Instruction
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Att1_Interview Form_Provider_REVISED_20170420v3.1.docx	Form and Instruction
DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Att2_Interview Form_Data-Clinic Manager_REVISED_20170420v1.0.docx	Form and Instruction
Generic Clearance for Qualitative Feedback Template Approval Form.docx GenIC Request Template - 0920-1050	IC Document
2017_STD Partner Feedback Assessment Summary.docx 0920-1050 GenIC Summary	IC Document

IC Title:

Partner Feedback Assessment Of Sexually Transmitted Disease (STD) Clinic Processes For Conducting And Documenting Routine HIV Testing

Agency IC Tracking Number:

0920-1050-17ASX

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic Provider Interview Guide	Att1_Interview Form_Provider_REVISED_20170420v3.1.docx	NA	No		Paper Only
Form and Instruction	NA	DSTDP Assessment: HIV testing in SSuN STD Clinics - STD Clinic/Data Manager Interview Guide	Att2_Interview Form_Data-Clinic Manager_REVISED_20170420v1.0.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	25	25
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template - 0920-1050	Generic Clearance for Qualitative Feedback Template Approval Form.docx	06/15/2017
0920-1050 GenIC Summary	2017_STD Partner Feedback Assessment Summary.docx	06/16/2017

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