NHBS Screening (All Respondent Groups)

[NCHHSTP] National HIV Behavioral Surveillance System

OMB: 0920-0770

IC ID: 182201

Information Collection (IC) Details

View Information Collection (IC)

NHBS Screening (All Respondent Groups)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0770 Eligibility Screener (English) Att 3a_Eligibility Screener_Eng.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0770 Eligibility Screener (Spanish) Att 4a_Eligibility Screener_Span.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

12,500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12,500 0 -2,500 0 0 15,000
Annual IC Time Burden (Hours) 1,042 0 -208 0 0 1,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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