NHBS Recruiter Debriefing

National HIV Behavioral Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0770 can be found here:

Documents and Forms

Document Name Document Type
NHBS Recruiter Debriefing Form and Instruction
Recruiter Debriefing (English) Att 3e_Recruiter_Debriefing_Eng.pdf Form and Instruction
Recruiter Debriefing (Spanish) Att 4e_Recruiter_Debriefing_Spanish.pdf Form and Instruction
Att 15_Recruiter training script.docx Recruiter Training Script IC Document

Information Collection (IC) Details

IC Title:	NHBS Recruiter Debriefing	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	N/A	Recruiter Debriefing (English)	Att 3e_Recruiter_Debriefing_Eng.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Recruiter Debriefing (Spanish)	Att 4e_Recruiter_Debriefing_Spanish.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,834	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,834	-333	4,167
Annual IC Time Burden (Hours)	128	-11	139
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Recruiter Training Script	Att 15_Recruiter training script.docx	12/08/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.