Community of Practice Pre-Assessment Instrument

Enhancing HIV Care of Women, Infants, Children and Youth Building Capacity through Communities of Practice

Documents and Forms

Document Name Document Type
Form 2 Community of Practice Pre-Assessment Instrument Form and Instruction
2 Community of Practice Pre-Assessment Form 2_COP Pre-Assessment Instrument.docx Form and Instruction
2 Community of Practice Pre-Assessment Form 2_COP Pre-Assessment Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Community of Practice Pre-Assessment Instrument	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	2	Community of Practice Pre-Assessment	Form 2_COP Pre-Assessment Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 180

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	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.