Information Collection

National Syringe Services Program (SSP) Evaluation

IC 248417 under ICR 202611-0920-005 · OMB 0920-1359.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0213 NSSSP Instrument_English National Syringe Services Program (SSP) Evaluation	Form and Instruction
Form 0920-26-0213 NSSSP Instrument_Spanish National Syringe Services Program (SSP) Evaluation	Form
0920-26-0213 NSSSP Instrument_English Attachment 6a_NSSSP Instrument_English.docx	Form and Instruction
0920-26-0213 NSSSP Instrument_Spanish Attachment 6b_NSSSP Instrument_Spanish.docx	Form

IC Title:

Agency IC Tracking Number:

0920-26-0213

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	0920-26-0213				Yes	Yes	Fillable Fileable
Form	0920-26-0213				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 600

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	583	583
Annual IC Cost Burden (Dollars)	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.

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