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Information Collection

SSuN Gonorrhea & Syphilis Patient Interview (Random Sampling)

IC 232371 under ICR 202503-0920-019 · OMB 0920-1072.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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SSuN Gonorrhea & Syphilis Patient Interview (Random Sampling) 0920-1072
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1072 SSuN Gonorrhea and Syphilis Patient Interview & STD Clinic Patient Questionnaire Att 8_Interview Forms_Clean.docx NA No   Fillable Fileable
Form and Instruction 0920-1072 SSuN Data Elements Att 5_SSuN Data Elements_Clean.xlsx No   Fillable Fileable

Health Public Health Monitoring

 

7,000 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,000 0 0 0 0 7,000
Annual IC Time Burden (Hours) 1,167 0 0 0 0 1,167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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