Phase 1 Enrollment Survey A

Identification of Behavioral and Clinical Predictors of Early HIV Infection (Project DETECT)

OMB: 0920-1100

IC ID: 218918

Information Collection (IC) Details

View Information Collection (IC)

Phase 1 Enrollment Survey A
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Phase 1 Enrollment Survey A (English) Att 6a_Phase 1 Enrollment Survey A (English).docx Yes Yes Fillable Fileable
Form and Instruction n/a Phase 1 Enrollment Survey A (Spanish) Att 6b_Phase 1 Enrollment Survey A (Spanish).docx Yes Yes Fillable Fileable
Form and Instruction n/a Phase 1 Enrollment Survey A (screen shots) Att 12a_Screenshots_Phase 1 Enrollment Survey A.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,667 0
   
Individuals or Households
 
   100 %

  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 1,667 0 0 0 0 1,667
Annual IC Time Burden (Hours) 1,250 0 0 0 0 1,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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