FY 2020 Ending the HIV Epidemic - Primary Care HIV Prevention (PHCP) Progress Reporting

The Health Center Program Application Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Document Name Document Type
Form 29 FY 2020 Ending the HIV Epidemic - Primary Care HIV Prevention (PHCP) Progress Reporting Form and Instruction
29 FY2020 Ending the HIV Epidemic Primary Care HIV Preventi FY2020 Ending the HIV Epidemic Primary Care HIV Prevention PCHP Progress Reporting.docx Form and Instruction
29 Progress Report PCHP Mark Up_add new report 10.30.20.doc Progress Report PCHP Mark Up_add new report 10.30.20.docx Form and Instruction
Change Memo - OMB PPR 2020_HRSA BPHC 11-24-2020.docx Change Memo - OMB PPR 2020_HRSA BPHC 11-24-2020 IC Document

Information Collection (IC) Details

IC Title:	FY 2020 Ending the HIV Epidemic - Primary Care HIV Prevention (PHCP) Progress Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	29	FY2020 Ending the HIV Epidemic Primary Care HIV Prevention PCHP Progress Reporting.docx	FY2020 Ending the HIV Epidemic Primary Care HIV Prevention PCHP Progress Reporting.docx		Yes	Yes	Fillable Fileable
Form and Instruction	29	Progress Report PCHP Mark Up_add new report 10.30.20.docx	Progress Report PCHP Mark Up_add new report 10.30.20.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 182	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	182	182
Annual IC Time Burden (Hours)	182	182
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Change Memo - OMB PPR 2020_HRSA BPHC 11-24-2020	Change Memo - OMB PPR 2020_HRSA BPHC 11-24-2020.docx	11/30/2020

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