Targeted and Intensive TA Assessment

Enhancing HIV Care of Women, Infants, Children and Youth Building Capacity through Communities of Practice

Documents and Forms

Document Name Document Type
Form 5 Targeted and Intensive TA Assessment Form and Instruction
5 Targeted and Intensive TA Assessment Form 5_Targeted and Intensive TA Assessment.docx Form and Instruction
5 Targeted and Intensive TA Assessment Form 5_Targeted and Intensive TA Assessment.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Targeted and Intensive TA Assessment	Agency IC Tracking Number:

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	5	Targeted and Intensive TA Assessment	Form 5_Targeted and Intensive TA Assessment.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 45

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
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.