HIV/AID Rapid Testing Clinical Information Form

Rapid HIV Testing Clinical Information Form for Minority AIDS Initiative (MAI) for Ethnic Racial Minorities at Risk for Substance Use and HIV/AIDS

⚠️ Notice: This information collection may be referencing outdated material.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 Form HIV/AID Rapid Testing Clinical Information Form Form and Instruction
Form Information Form RHTI Data Collection Tool 5-29-11-41am.doc Form and Instruction

Information Collection (IC) Details

IC Title:	HIV/AID Rapid Testing Clinical Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Form	Information Form	RHTI Data Collection Tool 5-29-11-41am.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 80

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	20,000	20,000
Annual IC Time Burden (Hours)	3,192	3,192
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.