Information Collection

HIV Case Control Study

IC 187011 under ICR 201303-0925-003 · OMB 0925-0597.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
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.