Event Record

HRSA AIDS Education and Training Centers (AETCs) Evaluation Activities

Documents and Forms

Document Name Document Type
B_Event Record Form_2021.pdf Instruction
B_Event Record Form_2021.pdf Instruction
Event Record_Final 5.4.2022.docx Event Record IC Document
Event Record_Final 5.4.2022.docx Event Record IC Document

Information Collection (IC) Details

IC Title:	Event Record	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
Instruction			B_Event Record Form_2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,980	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,980	12,980
Annual IC Time Burden (Hours)	2,596	2,596
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Event Record	Event Record_Final 5.4.2022.docx	06/30/2022

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