National HIV Prevention Program Monitoring and Evaluation (NHM&E) Data.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NHM&E Variables	Form	Modified	Available
NHM&E variables	Form	Modified	Available
NHM&E variables	Form	Modified	Repair queued
HIV test form - Pacific Islands	Form and Instruction	Modified	Repair queued
HIV test form - page 3	Form and Instruction	Modified	Available
HIV test form - page 2	Form and Instruction	Modified	Available
HIV test form - page 1	Form and Instruction	Modified	Available
NHM&E variables	Form	Modified	Available
HIV test scan form - Pacific Islands	Form and Instruction	Modified	Available
HIV test scan form - page 2	Form and Instruction	Modified	Available
HIV test scan form - page 1	Form and Instruction	Modified	Available
HIV test scan form - page 3	Form and Instruction	Modified	Available
NHM&E variables	Form	Modified	Available
Justification for OMB 0920-0696 Change Request_New HERR Variables_Oct122011.docx	Supplementary Document	Uploaded 2011-10-12	Available
OMB Change Request_ECHPP variables.docx	Supplementary Document	Uploaded 2011-08-15	Available
Justification for ECHPP OMB change request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-08-15	Available
Attachment 3 A PEMS Home Page.docx	Supplementary Document	Uploaded 2010-06-21	Available
Attachment 3 A PEMS Home Page.docx	Supplementary Document	Uploaded 2010-06-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7165	PEMS Data Collection for Health Jurisdictions	Form	Modified	NHM&E Variables
180698	PEMS Data Collection for Community-Based Organizations (Training)	Form	Modified	NHM&E variables
180697	PEMS Data Collection for Health Jurisdictions (Training)	Form	Modified	NHM&E variables
180696	Counseling, Testing and Referral for Community-Based Organizations	Form and Instruction	Modified	HIV test form - Pacific Islands
180696	Counseling, Testing and Referral for Community-Based Organizations	Form and Instruction	Modified	HIV test form - page 3
180696	Counseling, Testing and Referral for Community-Based Organizations	Form and Instruction	Modified	HIV test form - page 2
180696	Counseling, Testing and Referral for Community-Based Organizations	Form and Instruction	Modified	HIV test form - page 1
180695	PEMS Data Collection for Health Jurisdictions (HIV testing non-scan)	Form	Modified	NHM&E variables
180694	Counseling, Testing and Referral for Health Jurisdictions (CTR scan)	Form and Instruction	Modified	HIV test scan form - Pacific Islands
180694	Counseling, Testing and Referral for Health Jurisdictions (CTR scan)	Form and Instruction	Modified	HIV test scan form - page 2
180694	Counseling, Testing and Referral for Health Jurisdictions (CTR scan)	Form and Instruction	Modified	HIV test scan form - page 1
180694	Counseling, Testing and Referral for Health Jurisdictions (CTR scan)	Form and Instruction	Modified	HIV test scan form - page 3
180693	PEMS Data Collection for Community-Based Organizations	Form	Modified	NHM&E variables

ICR Details

OMB Control No: 0920-0696	ICR Reference No: 201108-0920-006
Status: Historical Active	Previous ICR Reference No: 201103-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National HIV Prevention Program Monitoring and Evaluation (NHM&E) Data.
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/12/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/18/2011
Terms of Clearance: Previous terms of clearance continue: Approved with the understanding that additional modifications to the collection may be made in light of the National HIV/AIDS Strategy released in 2010.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	08/31/2013	08/31/2013
Responses	3,580	0	3,580
Time Burden (Hours)	301,208	0	298,660
Cost Burden (Dollars)	0	0	0

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Abstract: The HIV Prevention Program Evaluation and Monitoring System (PEMS) collects standardized HIV prevention program data from health departments and community-based organizations. The data are used to monitor the delivery of prevention services data to clients and report on required program performance indicators. CDC requests minor changes to the variable collected.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Counseling, Testing and Referral for Community-Based Organizations	none, none, none, none	HIV test form - page 1 ,   HIV test form - page 2 ,   HIV test form - page 3 ,   HIV test form - Pacific Islands
Counseling, Testing and Referral for Health Jurisdictions (CTR scan)	none, none, none, none	HIV test scan form - page 3 ,   HIV test scan form - page 1 ,   HIV test scan form - page 2 ,   HIV test scan form - Pacific Islands
PEMS Data Collection for Community-Based Organizations	none	NHM&E variables
PEMS Data Collection for Community-Based Organizations (Training)	none	NHM&E variables
PEMS Data Collection for Health Jurisdictions	none	NHM&E Variables
PEMS Data Collection for Health Jurisdictions (HIV testing non-scan)	none	NHM&E variables
PEMS Data Collection for Health Jurisdictions (Training)	none	NHM&E variables

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,580	3,580	0	0	0	0
Annual Time Burden (Hours)	301,208	298,660	0	2,548	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $439,666

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/18/2011

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