Information Collection

HIV Case Control Study

IC 187011 under ICR 200810-0925-006 · OMB 0925-0597.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0597 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HIV Case Control Study	Form and Instruction
1 survey Attachment 1_English Questionnaire .RTF	Form and Instruction
Attachment 2_English Consent .doc Attachment 2_English Consent	IC Document

IC Title:

HIV Case Control Study

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	1	survey	Attachment 1_English Questionnaire .RTF		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

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	2,000	2,000
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2_English Consent	Attachment 2_English Consent .doc	10/08/2008

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