HIV Testing Form

Co-location and Integration of HIV Prevention and Medical Care into Behavioral Health Program

OMB: 0930-0343

IC ID: 212075

Information Collection (IC) Details

View Information Collection (IC)

HIV Testing Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction HIV Testing Form HIV Testing Form Attachment 1 Combined Testing Form (2).docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

5,000 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,000 0 5,000 0 0 0
Annual IC Time Burden (Hours) 650 0 650 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CGI Scale Attachment 5 CGI Scale.pdf 06/25/2014
KARNOFSKY PERFORMANCE STATUS SCALE Attachment 6 KARNOFSKY PERFORMANCE STATUS SCALE.doc 06/25/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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