Burden Table

Exhibit A.12-A. Estimated Annualized Burden Hours

Type of Respondent	Form Name	Number of Respondents	Number of Responses per Respondent	Average Burden per Response (in Hours)	Total Burden (in Hours)
Participating Clinic	Baseline data collection variables list	2	1	2	4
	Monthly study report form	2	12	15/60	6
HIV-negative patients seeking HIV testing and/or PrEP services	Release of information form	850	1	10/60	142
	Study visit survey	850	1	15/60	213
HIV-positive patients seeking STI testing	Release of information form	50	1	10/60	8
	Study visit survey	50	1	15/60	13
RCT of POC NAT or Standard of Care for HIV-positive patients	Release of information form	212	1	10/60	35
	Study visit survey	212	1	15/60	53
Survey Group examining POC NAT acceptability	POC NAT acceptability survey	500	1	20/60	167
Participants in cross-sectional comparison of several point-of-care NATs	Release of information form	333	1	10/60	56
	Study visit survey	333	1	15/60	83
Acceptability/feasibility assessment Group	Participant Focus Group/Interview Guide Gay City and Madison Clinic Testing, PEP & PrEP (participants testing negative only)	100	1	1	100
Total					880