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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.