Baseline Screener and Survey Screenshots

HIV Knowledge, Beliefs, Attitudes, and Practices of Providers in the Southeast

(K-BAP Study)

Attachment 9a

Screenshots

K-BAP Provider Baseline

Screener and Survey Instrument

SCREENSHOTS - K-BAP HEALTHCARE PROVIDER BASELINE SURVEY SCREENER

Form Approved

OMB No. 0920-XXXX

Expiration Date: XX/XX/XXXX

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)