Information Collection

Adult HIV/AIDS Confidential Case Report

IC 7028 under ICR 201301-0920-001 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0573 Adult HIV/AIDS Confidential Case Report	Form and Instruction
0920-0573 Adult HIV Confidential Case Report Form Final Att-3a Adult CRF (2).pdf	Form and Instruction
Final Att 3c_eHARS Variables (2).pdf Final Att 3c_eHARS Variables (2)	IC Document
Final Att-4a Adult Tech Guidance Vol 2 (2).pdf Final Att-4a Adult Tech Guidance Vol 2 (2)	IC Document

IC Title:

Adult HIV/AIDS Confidential Case Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	0920-0573	Adult HIV Confidential Case Report Form	Final Att-3a Adult CRF (2).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 59

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	74,340	-34,161	108,501
Annual IC Time Burden (Hours)	24,780	-11,387	36,167
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Final Att 3c_eHARS Variables (2)	Final Att 3c_eHARS Variables (2).pdf	12/19/2012
Final Att-4a Adult Tech Guidance Vol 2 (2)	Final Att-4a Adult Tech Guidance Vol 2 (2).pdf	12/19/2012

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