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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.