Information Collection

List of Site HIV Outpatient Ambulatory Medical Care Visits Activities/Services

IC 210746 under ICR 201403-0915-004 · OMB 0915-0381.

Documents and Forms

Document Name Document Type
Attachment C - List of HIV Site Outpatient Ambulatory Medical Care Activ....docx Other-interview

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	List of Site HIV Outpatient Ambulatory Medical Care Visits Activities/Services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-interview			Attachment C - List of HIV Site Outpatient Ambulatory Medical Care Activ....docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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