Phase 1 Enrollment Survey B

Identification of Behavioral and Clinical Predictors of Early HIV Infection (Project DETECT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1100 can be found here:

Documents and Forms

Document Name Document Type
Phase 1 Enrollment Survey B Form and Instruction
Phase 1 Enrollment Survey B (English) Att 7a_Phase 1 Enrollment Survey B - 2021_clean.docx Form and Instruction
Phase 1 Enrollment Survey B (English) Att 7a_Phase 1 Enrollment Survey B - 2021_clean.docx Form and Instruction
Phase 1 Enrollment Survey B (Spanish) Att 7b_Phase 1 Enrollment Survey B (Spanish).docx Form and Instruction
Phase 1 Enrollment Survey B (Spanish) Att 7b_Phase 1 Enrollment Survey B (Spanish).docx Form and Instruction
Phase 1 Enrollment Survey B (screen shots) Att 7a_Phase 1 Enrollment Survey B - Screenshots - 2021.docx Form and Instruction
Phase 1 Enrollment Survey B (screen shots) Att 7a_Phase 1 Enrollment Survey B - Screenshots - 2021.docx Form and Instruction
Phase 1 Enrollment Survey B (screen shots in Spanish) Att 12b_Screenshots_Phase1 Enrollment Survey B (Spanish).pdf Form and Instruction
Phase 1 Enrollment Survey B (screen shots in Spanish) Att 12b_Screenshots_Phase1 Enrollment Survey B (Spanish).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Phase 1 Enrollment Survey B	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Phase 1 Enrollment Survey B (English)	Att 7a_Phase 1 Enrollment Survey B - 2021_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Phase 1 Enrollment Survey B (Spanish)	Att 7b_Phase 1 Enrollment Survey B (Spanish).docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Phase 1 Enrollment Survey B (screen shots)	Att 7a_Phase 1 Enrollment Survey B - Screenshots - 2021.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Phase 1 Enrollment Survey B (screen shots in Spanish)	Att 12b_Screenshots_Phase1 Enrollment Survey B (Spanish).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,867	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	1,867	1,667	200
Annual IC Time Burden (Hours)	934	734	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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