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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	1.1	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 %

table that charts list of burden
	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

table that charts IC Documents
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.