CBO HIV Prevention Survey Screenshots

Form Approved
OMB No. 0920-New
Expiration Date: XX/XX/XXXX

Community-Based Organizations’ Changes in Preparedness and Resources for Support of Biomedical
HIV Prevention

Attachment 5
Survey Instrument

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance
Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

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