0920-0573 - Adult Case Report: AIDS

Adult and Pediatric HIV/AIDS Confidential Case Reports for National HIV/AIDS Surveillance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 50.42A 0920-0573 - Adult Case Report: AIDS Form
CDC 50.42A Att C_Adult HIV/AIDS Confidential Case Report Attachment C adult crf.pdf Form

Information Collection (IC) Details

IC Title:	0920-0573 - Adult Case Report: AIDS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 50.42A	Att C_Adult HIV/AIDS Confidential Case Report	Attachment C adult crf.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	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	Previously Approved
Annual Number of Responses for this IC	52,510	-27,471	79,981
Annual IC Time Burden (Hours)	17,503	4,312	13,191
Annual IC Cost Burden (Dollars)	0	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.