Qualitative Eligibility Screener

National HIV Behavioral Surveillance: Brief HIV Bio-behavioral Assessment (NHBS-BHBA)

OMB: 0920-1398

IC ID: 255847

Information Collection (IC) Details

View Information Collection (IC)

Qualitative Eligibility Screener
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Qualitative Eligibility Screener (English) Att 3e_Qualitative Eligibility Screener_Eng.docx Yes Yes Fillable Fileable
Form and Instruction None Qualitative Eligibility Screener (Spanish) Att 4e_Qualitative Eligibility Screener_Spa.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC  76 FR 4458

96 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 96 0 96 0 0 0
Annual IC Time Burden (Hours) 2 0 2 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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