0920-0255 NPIN Questionnaire for New Organizations-Doxy PEP_Free m

Form approved

OMB No.0920-0255

Exp. date: 03/312026

Resources and Services Database of the CDC National Prevention Information Network

Attachment 3A

NPIN Questionnaire for New Organizations

NPIN Questionnaire for New Organizations

Form approved OMB No.0920-0255 Exp. date: 03/31/2026
Public reporting burden of this collection of information is estimated to be 7 minutes per response, including searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor or respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA No. (0920-0255).

Note: Use this script when calling an organization to be added to the NPIN Organization Database.

When calling organizations, you need to first identify yourself and the reason for your call.

Hello, my name is __________________________ and I’m calling your organization on behalf of Centers for Disease Control and Prevention’s (CDC) National Prevention Information Network. NPIN provides resources and services related to HIV/AIDS, viral hepatitis, STDs, and Tuberculosis. The mission of NPIN is to serve the information needs of State and local HIV/AIDS/Viral Hepatitis/STD/TB program personnel and other professionals. We are creating a new record for ___________________< insert organization’s primary name> and want to make sure the information we have collected is accurate. The information we collect in the NPIN database is used to update the NPIN and Get Tested Websites, and other sites like AIDS.gov. Your participation is voluntary.

Next, ask the receptionist or operator to verify the following:

• Organization Name (including any department, division, or program)

  • Be sure to confirm the primary name.

• Organization’s Corporate address or mailing Address including:

Street 1, Street 2 (PO Box, Suite), City, County, State, Zip Code,

• Phone Number(s)

Main Phone, Fax Number, Toll Free Number, Other Numbers

Website

• Ask if the information on the website is accurate and up to date.

• Ask for a general email address.

• Ask for the email of staff contact person. It is important to get ask for an e-mail address for the staff contact(s) and inform the organization representative that going forward we will send an e-mail once a year to verify information.

• Hours of Operation

• Organization Type: Federally Qualified Health Center, Public Health Department, Clinic

If an operator is not available and you have the option, choose the appointment line. Often, the appointment line will provide information about hours of operation, eligibility criteria, and fees.

Next, ask to speak to the HIV program director/coordinator,

outreach staff OR the nursing supervisor to verify the following.

When possible, confirm this information from the website first:

• Fees for services

  • Testing fees

  • Vaccine fees

  • Free mpox vaccine

  • Fees for other services.

• Appointment information

• Eligibility restrictions

• Services Offered (Check the services that apply)

SUPPORT SERVICES	Ryan White Services
	PrEP Navigation
	Case Management
	Housing Opportunities for Persons with AIDS/HOPWA
	Drug Purchasing Assistance (ADAP)
CAPACITY BUILDING	Research
	Training Programs
	Health Professional Education
PREVENTION SERVICES	Needle Cleaning, Needle Exchange or Needle distribution
	TB Prevention/Education
	STD Prevention/Education
	HIV/AIDS Prevention/Education
	Harm Reduction
	Condom Distribution
TESTING SERVICES	Conventional HIV Testing
	Rapid HIV Testing
	HIV Self-Testing
	Gonorrhea Testing
	Chlamydia Testing
	Syphilis Testing
	Herpes Testing
	STD Self-Testing
	TB Testing
	Hepatitis A Testing
	Hepatitis B Testing
	Hepatitis C Testing
	Hepatitis Self-Testing
	Mobile Testing Services
	Self-Testing Distribution area:
	CARE AND TREATMENT SERVICES
TREATMENT SERVICES	Family Planning
	TB Treatment
	STD Treatment
	HPV Vaccine
	Pre-Exposure Prophylaxis (PrEP)
	HIV/AIDS Medical Treatment
	Post-Exposure Prophylaxis (PEP)
	Hepatitis C Treatment
	Hepatitis B Treatment
	Hepatitis A Vaccine
	Adult Hepatitis B Vaccine
	Substance Abuse Treatment
	Medication Adherence Education and Counseling
	Clinical Trials
	Mpox Vaccine
	Doxy PEP

• Audience Served: Ask for all the population groups targeted by the organization.

• Language: Includes de Language spoken by the staff.

Finally, thank the organization for helping with the collection of information.