Collaborative Assessment Tool (THRIVE Awardees)

Comprehensive HIV Prevention and Care for Men Who Have Sex with Men of Color

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1178 can be found here:

Documents and Forms

Document Name Document Type
Attachment 6 Collaborative Assessment Tool 11 22 2016 final.docx Instruction

Information Collection (IC) Details

IC Title:	Collaborative Assessment Tool (THRIVE Awardees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 6 Collaborative Assessment Tool 11 22 2016 final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	60	60

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.