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Att. 3f_Partnership Activities Form
Evaluation of Enhancing HIV Prevention Communication and Mobilization Efforts through Strategic Partnerships
OMB: 0920-1161
IC ID: 222052
OMB.report
HHS/CDC
OMB 0920-1161
ICR 201606-0920-014
IC 222052
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1161 can be found here:
2021-03-08 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
Att 3f Partnership Activities Form.docx
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att. 3f_Partnership Activities Form
Agency IC Tracking Number:
16LL
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-WORD
Att 3f Partnership Activities Form.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,000
0
2,000
0
0
0
Annual IC Time Burden (Hours)
833
0
833
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.