Information Collection

Adult HIV/AIDS Confidential Case Report

IC 7028 under ICR 201106-0920-003 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adult HIV/AIDS Confidential Case Report	Form
Adult Case Report Form ACRF 19May2011.pdf	Form
0920-0573_att 4(a) adult and ped instruct_Tech_Guidance_vol2.pdf Instructions for HIV/AIDS Confidential Case Report	IC Document
0920-0573_att 3(c)_eHARS Variables.doc EHARS Data Elements	IC Document

IC Title:

Adult HIV/AIDS Confidential Case Report

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Adult Case Report Form	ACRF 19May2011.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	108,501	108,501
Annual IC Time Burden (Hours)	36,167	36,167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for HIV/AIDS Confidential Case Report	0920-0573_att 4(a) adult and ped instruct_Tech_Guidance_vol2.pdf	11/30/2009
EHARS Data Elements	0920-0573_att 3(c)_eHARS Variables.doc	11/30/2009

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