Burden Table

Estimated Annualized Burden Hours

Type of Respondent	Form Name	Number of Respondents	Number of Responses per Respondent	Average Burden Per Response (in hours)	Total Burden (in hours)
Sampled, Eligible HIV-Infected Patients	Standard interview	7219	1	45/60	5,414
Sampled, Eligible HIV-Infected Patients Unable to Complete the Standard Interview	Short interview	301	1	20/60	100
Facility office staff pulling medical records		7,520	1	3/60	376
Facility office staff providing Estimated Patient Loads		936	1	2	1,872
Facility office staff providing patient lists		1,030	1	30/60	515
Facility office staff approaching participants for enrollment		3,120	1	5/60	260
Total					8,537