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HIV Practice Survey
HIV Clinician Workforce Study
OMB: 0915-0349
IC ID: 200546
OMB.report
HHS/HSA
OMB 0915-0349
ICR 201112-0915-006
IC 200546
( )
Documents and Forms
Document Name
Document Type
Form 1
HIV Practice Survey
Form and Instruction
Info_Brochure_Practice_Survey.pdf
Instruction
Study_Design_Report.pdf
Other-Study_Design_Report
1 HIV_Practice_Survey
HIV_Practice_Survey.pdf
Form and Instruction
2 Pre_and_post_test
Post-Pretest-Version-Questionnaire_Practice-Survey.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HIV Practice Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 and Instruction
1
HIV_Practice_Survey
HIV_Practice_Survey.pdf
Yes
Yes
Fillable Fileable
Instruction
Info_Brochure_Practice_Survey.pdf
Yes
No
Printable Only
Form and Instruction
2
Pre_and_post_test
Post-Pretest-Version-Questionnaire_Practice-Survey.pdf
Yes
Yes
Fillable Fileable
Other-Study_Design_Report
Study_Design_Report.pdf
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
350
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
350
0
350
0
0
0
Annual IC Time Burden (Hours)
175
0
175
0
0
0
Annual IC Cost Burden (Dollars)
9,517
0
9,517
0
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.