Aim 2a Cohort Screener (English/Spanish)

[NCHHSTP] _Expanding PrEP in Communities of Color (EPICC) (24BY)

OMB: 0920-1423

IC ID: 263120

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Aim 2a Cohort Screener (English/Spanish) 0920-1423-24BY
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction MOD00003217 Aim 2a Cohort Screener English Att 4f_Aim2aCohortScreenerEnglish CLEAN.docx Yes Yes Fillable Fileable
Form and Instruction V2023-1102 Elegibilidad de cohorte (Aim2aCohortScreener_Spanish) Att 4f.a_Aim2aCohortScreenerSpanish CLEAN.docx Yes Yes Fillable Fileable

Workforce Management Training and Employment

 

267 0
   
Individuals or Households
 
   0 %

  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 267 0 0 0 0 267
Annual IC Time Burden (Hours) 22 0 0 0 0 22
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 4f.1_Aim 2a Cohort Screener English Att 4f.1_Aim2aCohortScreenerEnglish (TC).docx 01/05/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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