Information Collection

National Syringe Services Program Evaluation

IC 248417 under ICR 202310-0920-001 · OMB 0920-1359.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-1359

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000	520	480
Annual IC Time Burden (Hours)	583	303	280
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.