Adult Questionnaire

Monitoring Data Collection Tools for the Minority AIDS Initiative (MAI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0357 can be found here:

Documents and Forms

Document Name Document Type
Form MAI Adult Question Adult Questionnaire Form and Instruction
MAI Adult Question MAI Adult Questionnaire 2021 20210706 MAI_Adult Questionnaire 2021 _ CLEAN 7-7-2021.docx Form and Instruction
MAI Adult Question MAI Adult Questionnaire 2021 20210706 MAI_Adult Questionnaire 2021 _ CLEAN 7-7-2021.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Adult Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	MAI Adult Questionnaire 2021	MAI Adult Questionnaire 2021	20210706 MAI_Adult Questionnaire 2021 _ CLEAN 7-7-2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	-4,000	24,000
Annual IC Time Burden (Hours)	4,000	-800	4,800
Annual IC Cost Burden (Dollars)	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.