Information Collection

Registration Form

IC 250068 under ICR 202110-0920-015 · OMB 0920-1370.

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.