HIV Case Control Study

The Prevalence and Incidence of HIV Molecular Variants and Their Correlation with Risk Behaviors and HIV Treatment in Brazilian Blood Donors (NHLBI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0597 can be found here:

Documents and Forms

Document Name Document Type
Form 1 HIV Case Control Study Form and Instruction
1 Questionnaire Attach_1_Brazil_HIV_Case_Study_Questionnaire_4_26_2012_V_7 0.docx Form and Instruction
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2.0.docx Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2 IC Document
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0.docx Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0 IC Document
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1.0.docx Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1 IC Document

Information Collection (IC) Details

IC Title:	HIV Case Control Study	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	1	Questionnaire	Attach_1_Brazil_HIV_Case_Study_Questionnaire_4_26_2012_V_7 0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2	Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2.0.docx	04/30/2012
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0	Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0.docx	04/30/2012
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1	Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1.0.docx	04/30/2012

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