Att 3_Web-Based Survey

Formative Research to Develop HIV Social Marketing Campaigns for Healthcare Providers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1182 can be found here:

Documents and Forms

Document Name Document Type
Att 3 Web-based Survey.docx Other-WORD
Att 3a_Web-based Survey screenshots.docx Other-Scrteenshots

Information Collection (IC) Details

IC Title:	Att 3_Web-Based Survey	Agency IC Tracking Number:	16TZ

Is this a Common Form? No		IC Status: New

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
Other-WORD			Att 3 Web-based Survey.docx		Yes	Yes	Fillable Fileable
Other-Scrteenshots			Att 3a_Web-based Survey screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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 Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	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.