OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Syringe Service Programs' (SSP) User Experiences

IC 233472 under ICR 202010-0920-010 · OMB 0920-1091.

Documents and Forms
Document Name
Document Type
Form
Other-Interview Guide
Other-Interview Guide
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Syringe Service Programs' (SSP) User Experiences 0920-1091-18BCZ
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Client Screener Att 2a_SSP Client Screening Form.docx Yes Yes Fillable Fileable
Form none Staff and Stakeholder Screener Att 2b_SSP Staff and Stakeholder Screening Form.docx Yes Yes Fillable Fileable
Form none Contact Information Form Att 2c_SSP Contact Form.docx No   Paper Only
Other-Interview Guide Att 2d_SSP Client In-Depth Interview Guide.docx Yes Yes Fillable Fileable
Other-Interview Guide Att 2e_SSP Staff and Stakeholder In-Depth Interview Guide.docx Yes Yes Fillable Fileable

Health Health Care Services

 

240 0
   
Individuals or Households
 
   75 %

  Requested 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 240 0 0 0 0 240
Annual IC Time Burden (Hours) 83 0 0 0 0 83
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A SSA.docx 10/11/2018
Supporting Statement B SSB.docx 10/11/2018
Client Consent Att 3a_SSP Client Informed Consent_CDC.docx 10/11/2018
Staff Consent Att 3b_SSP Staff and Stakeholder Informed Consent_CDC.docx 10/11/2018
IRB Approval Att 4_IRB Approval.docx 10/11/2018
Data Use Plan Att 5_Data Use Plan.doc 10/11/2018
Recruitment Materials Att 1_Recruitment Materials.pdf 10/11/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.