Information Collection

HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey

IC 247948 under ICR 202411-0920-009 · OMB 0920-1357.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1357 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1357 HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey	Form and Instruction
Form 0920-1357 Study Visit Survey HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey	Form and Instruction
Form 0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey	Form and Instruction
0920-1357 Study Visit Survey Att 11_GAIN study visit survey_screenshots_11-18-21.pdf	Form and Instruction
0920-1357 Study Visit Survey Att 11_GAIN study visit survey_screenshots_11-18-21.pdf	Form and Instruction
0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 Att 11_GAIN study visit survey_screenshots_changes accepted_082922.docx	Form and Instruction
0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 Att 11_GAIN study visit survey_screenshots_changes accepted_082922.docx	Form and Instruction

IC Title:

HIV-negative Patients Seeking HIV Testing and/or PrEP Services - Study Visit Survey

Agency IC Tracking Number:

0920-1357-24AQ

Is this a Common Form? No

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	0920-1357				Yes	Yes	Fillable Fileable
Form and Instruction	0920-1357			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	850	0	850
Annual IC Time Burden (Hours)	213	71	142
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].