Information Collection

Prospective Evaluation of Health Care Workers Exposed to Blood from Patients Infected with HIV

IC 6643 under ICR 199706-0920-002 · OMB 0920-0131.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Prospective Evaluation of Health Care Workers Exposed to Blood from Patients Infected with HIV

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	57.34B	No	No
Form	57.42A	No	No
Form	57.34E	No	No
Form	57.34C	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,125	1,125
Annual IC Time Burden (Hours)	198	198
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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