Client Screening & Consent

Preferences for Longer-Acting Preexposure Prophylaxis (PrEP) Methods Among Persons in US Populations at Highest Need: A Discrete Choice Experiment

Documents and Forms

Document Name Document Type
Form 0920 Client Screening & Consent Form and Instruction
0920 Client Screening & Consent Att 5 Client Screening & Consent.docx Form and Instruction
0920 Client Screening & Consent Att 5 Client Screening & Consent.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Client Screening & Consent	Agency IC Tracking Number:	0920-22CX

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 and Instruction	0920	Client Screening & Consent	Att 5 Client Screening & Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,050	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,050	8,050
Annual IC Time Burden (Hours)	1,342	1,342
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.