Information Collection

HIV Prevention Program Evaluation and Monitoring System for Health Departments and Community-Based Organizations (PEMS)

IC 7165 under ICR 200507-0920-001 · OMB 0920-0696.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0696 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	HIV Prevention Program Evaluation and Monitoring System for Health Departments and Community-Based Organizations (PEMS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 219	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,152	2,152
Annual IC Time Burden (Hours)	122,172	122,172
Annual IC Cost Burden (Dollars)	2,000	2,000

Documents for IC

Title	Document	Date Uploaded

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