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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.