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Medical Report On Adult/child With Allegation Of Human Immunodeficiency Virus (hiv) Infection

IC 115682 under ICR 199305-0960-001 · OMB 0960-0503.

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Information Collection (IC) Details

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MEDICAL REPORT ON ADULT/CHILD WITH ALLEGATION OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-4814 No No
Form 4815 No No


    

32,500 0
   
Individuals or Households
 
   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 32,500 0 0 0 0 32,500
Annual IC Time Burden (Hours) 5,417 0 0 1 0 5,416
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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