Information Collection

Att 3d_Increasing Access to Hepatitis C and/or Hepatitis B Testing and Linkage to Care in High-Impact Settings

IC 248660 under ICR 202403-0920-014 · OMB 0920-1353.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1353 Att 3d_Increasing Access to Hepatitis C and/or Hepatitis B Testing and Linkage to Care in High-Impact Settings	Form and Instruction
0920-1353 Increasing Access to Hepatitis C and/or Hepatitis B Test Att 3d_SUPP_APR_Form.docx	Form and Instruction
0920-1353 Increasing Access to Hepatitis C and/or Hepatitis B Test Att 3d_SUPP_APR_Form.docx	Form and Instruction
Att5d_Supplemental Activity Instructions.docx Att 5d_Supplemental Viral Hepatitis Prevention Activities	IC Document
Att5d_Supplemental Activity Instructions.docx Att 5d_Supplemental Viral Hepatitis Prevention Activities	IC Document

IC Title:

Agency IC Tracking Number:

0920-1353

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-1353	Increasing Access to Hepatitis C and/or Hepatitis B Testing and Linkage to Care in High-Impact Settings	Att 3d_SUPP_APR_Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8	-110	118
Annual IC Time Burden (Hours)	6	-33	39
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 5d_Supplemental Viral Hepatitis Prevention Activities	Att5d_Supplemental Activity Instructions.docx	03/22/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.