Phase 1 Enrollment Survey

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

Documents and Forms

Document Name Document Type
Form 0920-1100 Phase 1 Enrollment Survey Form and Instruction
Att 12a_Screenshots_REDCaP_Phase 1 Enrollment Survey.pdf Other-Screenshot
Att 12a_Screenshots_REDCaP_Phase 1 Enrollment Survey.pdf Other-Screenshot
0920-1100 Att 7a_Phase 1 Enrollment Survey (English) Prt2 Wrksht_att 7_Phase 1 Enrollment Survey.pdf Form and Instruction
0920-1100 Att 7a_Phase 1 Enrollment Survey (English) Prt2 Wrksht_att 7_Phase 1 Enrollment Survey.pdf Form and Instruction
0920-1100 Att 7b_Phase 1 Enrollment Survey (Spanish) Att 7b_Phase 1 Enrollment Survey (Spanish).docx Form and Instruction
0920-1100 Att 7b_Phase 1 Enrollment Survey (Spanish) Att 7b_Phase 1 Enrollment Survey (Spanish).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Phase 1 Enrollment Survey	Agency IC Tracking Number:	0920-1100

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	0920-1100	Att 7a_Phase 1 Enrollment Survey (English)	Prt2 Wrksht_att 7_Phase 1 Enrollment Survey.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1100	Att 7b_Phase 1 Enrollment Survey (Spanish)	Att 7b_Phase 1 Enrollment Survey (Spanish).docx	Yes	Yes	Fillable Fileable
Other-Screenshot			Att 12a_Screenshots_REDCaP_Phase 1 Enrollment Survey.pdf	Yes	Yes	Printable Only

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	Previously Approved
Annual Number of Responses for this IC	1,867	1,867
Annual IC Time Burden (Hours)	934	934
Annual IC Cost Burden (Dollars)	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.