OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Assessment of a Comprehensive HIV Clinic-based Intervention to Improve Patients' Health and Reduce Transmission Risk

OMB 0920-1002 · HHS/CDC.

OMB 0920-1002

Latest Forms, Documents, and Supporting Material

Document Name
Provider Survey (English Only) Form and Instruction
Patient Exit Survey (English, Spanish & Creole) Form and Instruction
Computer-Based Intervention Assessment Items (English&Spanish) Form and Instruction
Patient Behavior Screener (for English, Spanish & Creole) Form and Instruction
Supporting Statement B.docx Supporting Statement B
App 2 60-Day FRN Published.pdf Supplementary Document
App 15 Project Determination.pdf Supplementary Document
App 3 Clinical&Dem Variables.docx Supplementary Document
App 13 IRB approvals from participating sites.docx Supplementary Document
Supporting Statement A.docx Supporting Statement A
Provider Survey (English Only) Form and Instruction
Patient Exit Survey (English, Spanish & Creole) Form and Instruction
Computer-Based Intervention Assessment Items (English&Spanish) Form and Instruction
Patient Behavior Screener (for English, Spanish & Creole) Form and Instruction
Electronic Transmittal of Clinical Variables Archived in Clinic Databases--Data Manager/no form Other-Records/Data extraction

All Historical Document Collections

201311-0920-005

Approved without change

New collection (Request for a new OMB Control Number)

2013-11-08