Information Collection

Building Futures: Supporting Youth Living with HIV

IC 223014 under ICR 201608-0906-001 · OMB 0906-0023.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP Building Futures: Supporting Youth Living with HIV	Form and Instruction
Form 2 Onsite_Observational_Tool Building Futures: Supporting Youth Living with HIV	Form and Instruction
Instrument_3_Program_Manager_and_Clinical_Director_Interview_Guide_Specialized.docx	Other-Interview
Instrument_4_Program_Manager_and_Clinical_Director_Interview_Guide_PI.docx	Other-Interview
Instrument_5_Program_and_Administrative_Staff_Interview_Guide_Specialized.docx	Other-Interview
Instrument_6_Program_and_Administrative_Staff_Interview_Guide_PI.docx	Other-Interview
Instrument_7_Youth_Focus_Group.docx	Other-Interview
Instrument_8_Youth_Interview.docx	Other-Interview
Instrument_9_Panel_Advisory_Board.docx	Other-Interview
1 Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP Instrument_1_Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP.docx	Form and Instruction
2 Onsite_Observational_Tool Instrument_2_Onsite_Observational_Tool.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only
Other-Interview		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 496

Number of Respondents for Small Entity: 96

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	496	496
Annual IC Time Burden (Hours)	523	523
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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