Form Approved
OMB No. 0920-New
Expiration Date: XX/XX/XXXX
“Community-based Organization Outcome Monitoring Projects for CBO HIV Prevention Services Clients”
Secure Data Network (SDN) Submission
This form identifies the monthly submission of completed participant interviews, follow-up interviews, CBO-HPS staff interviews and focus groups via an SDN submission of the data files.
Grantee_______________________________________________________
Brief Description of data submission elements ______________________________________________________________________________________________________________________________________________________________________________________
Date grantee submitted the data to CDC via the SDN __/__/____.
Public reporting burden of this collection of information is estimated to average 10 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (xxx-xxx).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CDC User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |