Registration Form

National Learning Community for HIV CBO Leadership Evaluation

Documents and Forms

Document Name Document Type
Form 0920- Registration Form Form
0920- National Learning Community for HIV CBO Leadership Regis Att 4_Registration Form.docx Form
Att 5_Screenshots of Registration Form.docx Screenshots of National Learning Community for HIV CBO Leadership Registration Form IC Document
Att 6_Email reminder for Registration Form.docx Email reminder_Registration Form (completion) IC Document

Information Collection (IC) Details

IC Title:	Registration Form	Agency IC Tracking Number:	0920-21EL

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	0920-	National Learning Community for HIV CBO Leadership Registration Form	Att 4_Registration Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-20-0161 Records of Health Professionals in Disease Prevention and Control Training Programs	FR Citation: 83 FR 6591

Number of Respondents: 270	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	270	270
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Screenshots of National Learning Community for HIV CBO Leadership Registration Form	Att 5_Screenshots of Registration Form.docx	11/03/2021
Email reminder_Registration Form (completion)	Att 6_Email reminder for Registration Form.docx	11/03/2021

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