Information Collection

Att 3r: HIV Communication and Awareness Brief Survey Instrument

IC 225013 under ICR 201701-0920-001 · OMB 0920-1169.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1169 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3r Brief Survey-Comm and Aware.docx	Other-WORD

IC Title:

Att 3r: HIV Communication and Awareness Brief Survey Instrument

Agency IC Tracking Number:

16ATI

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 3r Brief Survey-Comm and Aware.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.