Information Collection

HIV Indicators

IC 212088 under ICR 201406-0930-004 · OMB 0930-0343.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0343 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Program Specific I HIV Indicators	Form and Instruction
Program Specific I Program Specific Indicators Attachment 3 Program Specific Indicators with updated directions.docx	Form and Instruction

IC Title:

HIV Indicators

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Program Specific Indicators	Program Specific Indicators	Attachment 3 Program Specific Indicators with updated directions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.