Information Collection

HIV Risk Factor

IC 187040 under ICR 200810-0925-007 · OMB 0925-0596.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0596 can be found here:

Documents and Forms

Document Name Document Type
Form 1.1 HIV Risk Factor Form and Instruction
1.1 HIV Attachment 1 1_HIV Qx.doc Form and Instruction
Attachment 2.1_Consent Cases HIV.doc Attachment 2 IC Document
Attachment 2.2_Consent Controls HIV.doc Attachment 2 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIV Risk Factor	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	1.1	HIV	Attachment 1 1_HIV Qx.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,050	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,050	1,050
Annual IC Time Burden (Hours)	347	347
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 2	Attachment 2.1_Consent Cases HIV.doc	10/22/2008
Attachment 2	Attachment 2.2_Consent Controls HIV.doc	10/22/2008

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