Form 0920-0255 Questionnarier for Annual Updates Telephone

Resources and Services Database of the National Prevention Information Network

Att 3B_NPIN Questionnaire for Annual Updates

NPIN Questionnaire for Annual Updates (Telephone)

OMB: 0920-0255

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Form Approved

OMB No. 0920-0255

Exp. date: XX/XX/XXXX










Resources and Services Database of the CDC National Prevention Information Network



Attachment 3B

NPIN Questionnaire for Annual Updates












Public reporting burden of this collection of information is estimated to be 6 minutes per response, including searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, or respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA No. (0920-0255).


NPIN Questionnaire for Annual Updates

Form approved OMB No.0920-0255 Exp. date: XX/XX/XXXX


Public reporting burden of this collection of information is estimated to be 6 minutes per response, including searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, or respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA No. (0920-0255).


Note: Use this script when calling an Organization to verify the information already in the database.

When calling organizations, you need to first identify yourself and the reason for your call.


Hello, my name is __________________________ and I’m calling your organization on behalf of Centers for Disease Control and Prevention’s (CDC) National Prevention Information Network. NPIN provides resources and services related to HIV/AIDS, viral hepatitis, STDs, and Tuberculosis. The mission of NPIN is to serve the information needs of State and local HIV/AIDS/Viral Hepatitis/STD/TB program personnel and other professionals. We are updating the NPIN Organizations Database and want to make sure the information we have for ___________________< insert organization’s primary name> is accurate. The information we collect in the NPIN database is used to update the NPIN and Get Tested Websites, and other sites like AIDS.gov. Your participation is voluntary.



Next, ask the receptionist or operator to verify the following:

  • Name

    • Be sure to confirm the primary name.

  • Address

  • Phone Number(s)

  • Website

    • Ask if the information on the website is accurate and up to date.

    • Get general e-mail address (es) from website.

  • Hours of Operation

  • 501(c)(3) status

  • Service level

If an operator is not available and you have the option, choose the appointment line. Often times, the appointment line will provide information about hours of operation, eligibility criteria, and fees.



Next, ask to speak to the HIV program director/coordinator OR the nursing supervisor to verify the following:


  • Testing Fees

  • Appointment information

  • Eligibility restrictions

  • Services Offered. Read the services listed on the existing record. Mark any changes below.



Prevention Education


HIV Testing


Financial Assistance



Conventional HIV test


ADAP


Mobile testing

Funding



Rapid HIV Test


Funding to Orgs

Hepatitis Testing


Legal Services



Hepatitis A testing




Hepatitis B testing

Medical Services



Hepatitis C rapid test


Clinical Trials


Hepatitis C testing


Family Planning

STD Testing



Primary Care


Chlamydia

Hepatitis Medical Services

Adult Hepatitis B Vaccine


Gonorrhea


Hepatitis A Vaccine


Herpes


Hepatitis
B treatment


Syphilis


Hepatitis C treatment

TB testing


HIV/AIDS Medical



TB testing


Alternative Medicine

Counseling

HIV test Counseling


HIV/AIDS Medical Tx


Partner notification


PEP

Research



PrEP

Social Services


STD Medical Services

HP Vaccine


Case Management


STD Treatment


Ryan White



  • Audiences Served. Read the audience selected on the existing record. Mark any changes below.



General Public

Persons with HIV/AIDS

Low income

Persons with Tuberculosis

Men

Persons with Hepatitis

Women

Persons with STD

LGBT

Minorities

At risk population

Other





  • Languages Spoken

Finally, thank the organization for updating the information.




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