Register to Access HIV Testing Course

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User Information

Public Burden Statement: The information on this form is collected under the authority of 42 U.S.C., Section 243 (CDC). The requested information is used only to process your training registration and will be disclosed only upon your written request. Continuing education credit can only be provided when all requested information is submitted. Furnishing the information requested on this form is voluntary.

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0017).

Please use the form below to create an account. Note: Passwords are required to be a minimum of 6 characters in length. Fields marked with an asterisk * are required. (check for proper format; some special characters may not be permitted.)

Your Unique ID number is a four letter, eight digit sequence. We recommend you use the first two letters of your first name, the first two letters of your last name, the month of your birth, the day of your birth, and the last four digits of your social security number. For example: John Smith, May 29, 123-45-6789 would be JOSM05296789.

   
      Picture of Unique ID format

     

     

   

   

Please complete the participant information form below.

 

   

 








 

   

   

Some programs and organizations provide services to a particular population group. In the following questions, please tell us about the population groups your program or organization serves.














 





(Round up to the nearest whole year)