NHBS Recruiter Debriefing

National HIV Behavioral Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0770 NHBS Recruiter Debriefing Form and Instruction
0920-0770 Recruiter Debriefing (English) Att 3e_Recruiter_Debriefing_Eng.pdf Form and Instruction
0920-0770 Recruiter Debriefing (Spanish) Att 4e_Recruiter_Debriefing_Spanish.pdf Form and Instruction
Att 15_Recruiter training script.docx Recruiter Training Script IC Document

Information Collection (IC) Details

IC Title:	NHBS Recruiter Debriefing	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-0770	Recruiter Debriefing (English)	Att 3e_Recruiter_Debriefing_Eng.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0770	Recruiter Debriefing (Spanish)	Att 4e_Recruiter_Debriefing_Spanish.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,167	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	Previously Approved
Annual Number of Responses for this IC	4,167	333	3,834
Annual IC Time Burden (Hours)	139	11	128
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Recruiter Training Script	Att 15_Recruiter training script.docx	09/27/2019

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