HIV-negative Patients Seeking HIV Testing - Study Visit Survey

[NCHHSTP] The GAIN (Greater Access and Impact with NAT) Study: Improving HIV Diagnosis, Linkage to Care, and Prevention Services with HIV Point-of-Care Nucleic Acid Tests (NATs)

Documents and Forms

Document Name Document Type
Form 0920-1357 HIV-negative Patients Seeking HIV Testing - Study Visit Survey Form
0920-1357 Study Visit Survey (SCREENSHOTS) Att 11_GAIN study visit survey_screenshots_11-18-21.pdf Form
0920-1357 GAIN Study Visit Survey - Revised 09SEP2022 (SCREENSHOTS Att 11_GAIN study visit survey_screenshots_changes accepted_082922.docx Form

Information Collection (IC) Details

IC Title:	HIV-negative Patients Seeking HIV Testing - Study Visit Survey	Agency IC Tracking Number:	0920-1357-24AQ

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1357	Study Visit Survey (SCREENSHOTS)	Att 11_GAIN study visit survey_screenshots_11-18-21.pdf		Yes	Yes	Printable Only
Form	0920-1357	GAIN Study Visit Survey - Revised 09SEP2022 (SCREENSHOTS)	Att 11_GAIN study visit survey_screenshots_changes accepted_082922.docx	NA	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.