Community-Based Organization HIV Prevention Survey

Community-Based Organizations’ Changes in Preparedness and Resources for Support of Biomedical HIV Prevention

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1321 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20HR Community-Based Organization HIV Prevention Survey Form and Instruction
0920-20HR CBO HIV Prevention Survey Att 5a_Survey Instrument.docx Form and Instruction
0920-20HR CBO HIV Prevention Survey Att 5a_Survey Instrument.docx Form and Instruction
Att 5b_Survey Instrument.pdf CBO HIV Prevention Survey Screenshots IC Document
Att 5b_Survey Instrument.pdf CBO HIV Prevention Survey Screenshots IC Document

Information Collection (IC) Details

IC Title:	Community-Based Organization HIV Prevention Survey	Agency IC Tracking Number:	0920-20HR

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	0920-20HR	CBO HIV Prevention Survey	Att 5a_Survey Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 330	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	330	330
Annual IC Time Burden (Hours)	165	165
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CBO HIV Prevention Survey Screenshots	Att 5b_Survey Instrument.pdf	08/25/2020

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