PEMS Data Collection for Health Jurisdictions (CTR non-scan)

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
PEMS Data Collection for Health Jurisdictions (CTR non-scan) Form and Instruction
PEMS Data Variables and Values for Health Departments Attachment C1. PEMS 3.0 Variables for Health Depts.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	PEMS Data Collection for Health Jurisdictions (CTR non-scan)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	None	PEMS Data Variables and Values for Health Departments	Attachment C1. PEMS 3.0 Variables for Health Depts.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	116	116
Annual IC Time Burden (Hours)	19,140	19,140
Annual IC Cost Burden (Dollars)	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.