Case Report Updates

Adult and Pediatric HIV/AIDS Confidential Case Reports for National HIV/AIDS Surveillance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Document Name Document Type
Case Report Updates Form
Adult HIV/AIDS Confidential Case Report 0920-0573_att 3(a) CDC 50.42A adult form_wcover.pdf Form
Pediatric HIV/AIDS Confidential Case Report 0920-0573_att 3(b) pediatric CDC 50 42B_wcover.pdf Form

Information Collection (IC) Details

IC Title:	Case Report Updates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Adult HIV/AIDS Confidential Case Report	0920-0573_att 3(a) CDC 50.42A adult form_wcover.pdf		Yes	Yes	Fillable Fileable
Form	none	Pediatric HIV/AIDS Confidential Case Report	0920-0573_att 3(b) pediatric CDC 50 42B_wcover.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC	FR Citation: 57 FR 62812

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,723	708	5,015
Annual IC Time Burden (Hours)	477	59	418
Annual IC Cost Burden (Dollars)	0	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.