Information Collection

Adult

IC 187120 under ICR 201208-0930-001 · OMB 0930-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0298 can be found here:

Documents and Forms

Document Name Document Type
Form Adult Questionnair Adult Form
Adult Questionnair Adult Questionnaire HIV Adult Questionnaire_120321.docx Form
HIVOverarching Guide Cohort N.docx Overarching Guide IC Document
HIV Adult Admin Guide 120321_Cleaned.docx Adult Admin Guide IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult	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	Adult Questionnaire	Adult Questionnaire	HIV Adult Questionnaire_120321.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,685	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
Annual Number of Responses for this IC	16,820	16,820
Annual IC Time Burden (Hours)	12,340	12,340
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Overarching Guide	HIVOverarching Guide Cohort N.docx	07/16/2012
Adult Admin Guide	HIV Adult Admin Guide 120321_Cleaned.docx	07/16/2012

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