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National Syringe Services Program Evaluation
[NCHHSTP] National Syringe Services Program (SSP) Evaluation
OMB: 0920-1359
IC ID: 248417
OMB.report
HHS/CDC
OMB 0920-1359
ICR 202310-0920-001
IC 248417
( )
Documents and Forms
Document Name
Document Type
National Syringe Services Program Evaluation
Form and Instruction
NSSSP Instrument 2024+
Att 7a_NSSSP Instrument 2024+_final.docx
Form and Instruction
NSSSP Instrument 2024+
Att 7a_NSSSP Instrument 2024+_final.docx
Form and Instruction
NSSSP Instrument 2024+ (Spanish)
Att 7b_Spanish version_NSSSP Instrument 2024+_final.docx
Form and Instruction
NSSSP Instrument 2024+ (Spanish)
Att 7b_Spanish version_NSSSP Instrument 2024+_final.docx
Form and Instruction
Att 9_Screenshot of NSSSP 2024+_final.pdf
Screenshots NSSSP Instrument 2024+
IC Document
Att 9_Screenshot of NSSSP 2024+_final.pdf
Screenshots NSSSP Instrument 2024+
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
National Syringe Services Program Evaluation
Agency IC Tracking Number:
0920-1359
Is this a Common Form?
Yes
IC Status:
Modified
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
n/a
NSSSP Instrument 2024+
Att 7a_NSSSP Instrument 2024+_final.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
NSSSP Instrument 2024+ (Spanish)
Att 7b_Spanish version_NSSSP Instrument 2024+_final.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
600
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
90 %
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
1,000
0
520
0
0
480
Annual IC Time Burden (Hours)
583
0
303
0
0
280
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screenshots NSSSP Instrument 2024+
Att 9_Screenshot of NSSSP 2024+_final.pdf
10/13/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.