YMSM Clinical Form

"Cohort Study of HIV, STIs and Preventive Interventions among Young MSM in Thailand

Documents and Forms

Document Name Document Type
Att 13_YMSM Clinical Form.docx Other-WORD

Information Collection (IC) Details

IC Title:	YMSM Clinical Form	Agency IC Tracking Number:	16JD

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 13_YMSM Clinical Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 167	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
Annual Number of Responses for this IC	668	668
Annual IC Time Burden (Hours)	223	223
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.