Follow-up of Immigrants or Refugees with Human Immunodeficiency Virus (HIV) Infection After Resettlement

Application for Waiver of Inadmissibility Under Immigration and Nationality Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0006 can be found here:

Documents and Forms

Document Name Document Type
0920-0006_ATT 4b_CDC Form 4-422-1b_HIV after Settlement.pdf Other-WORD

Information Collection (IC) Details

IC Title:	Follow-up of Immigrants or Refugees with Human Immunodeficiency Virus (HIV) Infection After Resettlement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-WORD			0920-0006_ATT 4b_CDC Form 4-422-1b_HIV after Settlement.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-02-0102: Alien Mental Waiver Program	FR Citation: 51 FR 42461

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	67	67
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.