Information Collection

HIV/AID Rapid Testing Clinical Information Form

IC 185896 under ICR 200807-0930-002 · OMB 0930-0295.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0295 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HIV-AIAN/RHTI Data HIV/AID Rapid Testing Clinical Information Form	Form
HIV-AIAN/RHTI Data HIV-AIAN/RHTI Data Collection Form RHTI Data Collection Tool AI-AN v4 (3).doc	Form
CDC PEMS Form as of 2 2 08.pdf HIV-AIAN\CDC PEMS Form	IC Document

IC Title:

HIV/AID Rapid Testing Clinical Information Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HIV-AIAN/RHTI Data Collection Form	HIV-AIAN/RHTI Data Collection Form	RHTI Data Collection Tool AI-AN v4 (3).doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

Number of Respondents for Small Entity: 798

Affected Public: State, Local, and Tribal Governments

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	50,000	50,000
Annual IC Time Burden (Hours)	8,350	8,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HIV-AIAN\CDC PEMS Form	CDC PEMS Form as of 2 2 08.pdf	07/24/2008

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