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Assessment of Partnerships Impacting STD Outcomes in Areas of Service Reduction

IC 231786 under ICR 201711-0920-012 · OMB 0920-0879.

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Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
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Information Collection (IC) Details

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Assessment of Partnerships Impacting STD Outcomes in Areas of Service Reduction 0920-0879-18ANY
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0879 STD Program Manager Referral Form Attachment B- STD Program Manager Referral Form.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0879 In-Person Interview Referral Form Attachment C- In-person Interview Referral Form.docx NA Yes Yes Fillable Fileable
Form and Instruction 0920-0879 Web-based Assessment Instrument Attachment E- EPP Web-based Instrument-Web Version.pdf NA Yes Yes Fillable Fileable
Form and Instruction 0920-0879 In-Person Interview Guide - Local STD Program Manager Attachment F- EPP- In-Person Interview Guide STD Program Manager and STD Program Coordinator.docx NA No   Paper Only
Form and Instruction 0920-0879 In-Person Interview Guide - Local STD Program Coordinator Attachment F- EPP- In-Person Interview Guide STD Program Manager and STD Program Coordinator.docx NA No   Paper Only
Form and Instruction 0920-0879 In-Person Interview Guide - Local Data Manager/Epidemiologist Attachment G- EPP- In-Person Interview Guide Data Manager.docx NA No   Paper Only

Health Consumer Health and Safety

 

184 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 184 0 184 0 0 0
Annual IC Time Burden (Hours) 132 0 132 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Assessment of Partnerships Impacting STD Outcomes in Areas of Service Reduction: Project Overview Attachment H- EPP Overview - Assessment of Partnerships Impacting STD Outcomes 1pg format.docx 06/14/2018
Respondent Breakdown Attachment A-Respondent Breakdown.docx 06/14/2018
Web-based Assessment - Invitation Email Attachment I- Web-based Assessment Invitation Email.docx 06/14/2018
Web-based Assessment - Reminder Email 1 Attachment J- Web-based Assessment Reminder Email 1.docx 06/14/2018
Web-based Assessment - Reminder Email 2 Attachment K- Web-based Assessment Reminder Email 2.docx 06/14/2018
In-Person Interview Invitation Email Attachment L-In-Person Interview Invitation Email.docx 06/14/2018
In-Person Interview Reminder Email Attachment M- In-Person Interview Reminder Email.docx 06/14/2018
Supporting Statement A EPP-SSA.docx 06/14/2018
Supporting Statement B EPP-SSB.docx 06/14/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.