NEST Survey - Study Participant

Network Epidemiology of Syphilis Transmission (NEST)

Documents and Forms

Document Name Document Type
NEST Survey - Study Participant Form and Instruction
NEST - Questionnaire and Data Elements Att 3_Questionnaire and Data Elements.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NEST Survey - Study Participant	Agency IC Tracking Number:

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
Form and Instruction	NA	NEST - Questionnaire and Data Elements	Att 3_Questionnaire and Data Elements.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 720	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	3,600	3,600
Annual IC Time Burden (Hours)	5,400	5,400
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.