National HIV Behavioral Surveillance System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0770 Attachment 3d Behavioral Assessment (HET) Spanish version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 2d Behavioral Assessment (HET) English version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 2c Behavioral Assessment (IDU) English version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 3c Behavioral Assessment (IDU) Spanish version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 3e Recruiter Debrief Spanish version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 2e Recruiter Debriefing English version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 3b Behavioral Assessment (MSM) Spanish version	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 2b	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 2A	Form and Instruction	Modified	Available
Form 0920-0770 Attachment 3a	Form and Instruction	Modified	Available
NHBS_Round3_Q-aire_v13_Redlined_5Dec11.docx	Supplementary Document	Uploaded 2011-12-14	Repair queued
NHBS_Round3_Q-aire_v13_Clean_5Dec11.docx	Supplementary Document	Uploaded 2011-12-14	Available
0920-0770_OMB_Justification_5Dec2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-12-14	Available
0920-0770_Att 15_Recruiter Training Script.pdf	Supplementary Document	Uploaded 2011-03-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Attachment 3d Behavioral Assessment (HET) Spanish version
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Attachment 2d Behavioral Assessment (HET) English version
196957	NHBS Behavioral Assessment (IDU)	Form and Instruction	Modified	Attachment 2c Behavioral Assessment (IDU) English version
196957	NHBS Behavioral Assessment (IDU)	Form and Instruction	Modified	Attachment 3c Behavioral Assessment (IDU) Spanish version
196956	NHBS Recruiter Debriefing	Form and Instruction	Modified	Attachment 3e Recruiter Debrief Spanish version
196956	NHBS Recruiter Debriefing	Form and Instruction	Modified	Attachment 2e Recruiter Debriefing English version
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Attachment 3b Behavioral Assessment (MSM) Spanish version
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Attachment 2b
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Attachment 2A
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Attachment 3a

ICR Details

OMB Control No: 0920-0770	ICR Reference No: 201112-0920-012
Status: Historical Active	Previous ICR Reference No: 201103-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National HIV Behavioral Surveillance System
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 without change	Conclusion Date: 12/21/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/19/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	05/31/2014	05/31/2014
Responses	31,668	0	31,668
Time Burden (Hours)	9,932	0	9,932
Cost Burden (Dollars)	0	0	0

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Abstract: This is a change request to submit a revised questionnaire to improve understandability and responses.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
   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? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
NHBS Behavioral Assessment (IDU)	0920-0770, 0920-0770	Attachment 3c Behavioral Assessment (IDU) Spanish version ,   Attachment 2c Behavioral Assessment (IDU) English version
NHBS Behavioral Assessment (MSM)	0920-0770, 0920-0770	Attachment 2b ,   Attachment 3b Behavioral Assessment (MSM) Spanish version
NHBS Behavioral Assessment Survey (HET)	0920-0770, 0920-0770	Attachment 2d Behavioral Assessment (HET) English version ,   Attachment 3d Behavioral Assessment (HET) Spanish version
NHBS Recruiter Debriefing	0920-0770, 0920-0770	Attachment 2e Recruiter Debriefing English version ,   Attachment 3e Recruiter Debrief Spanish version
NHBS Screening (All Respondent Groups)	0920-0770, 0920-0770	Attachment 3a ,   Attachment 2A

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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	31,668	31,668	0	0	0	0
Annual Time Burden (Hours)	9,932	9,932	0	0	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: $12,710,009

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? Yes

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: 12/19/2011

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