National HIV Surveillance System (NHSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0573 Adult HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
PHER (mondfied)	Form	Modified	Available
Form 0920-0573 Final Att 4c_Incidence TG append (2)	Form and Instruction	Unchanged	Repair queued
Form 0920-0573 Final Att-3a Adult CRF (2)	Form and Instruction	Unchanged	Available
Pediatric HIV/AIDS Confidential Case Report	Form	Unchanged	Available
Form 0920-0573 Pediatric HIV Confidential Case Report Form	Form	Unchanged	Repair queued
Form 0920-0573 Final Att 3d_MHS data elements (2)	Form and Instruction	Unchanged	Available
Form 0920-0573 Final Att 5_2009-2012 Publications	Form and Instruction	Unchanged	Available
Att 3- 0920-0573_Proposed Changes_PHER_8Aug2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-09-05	Available
Final SS-B.doc	Supporting Statement B	Uploaded 2012-12-19	Available
Final Att-8a Assurance of Conf.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 10b_ Statistical Consult Part List.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 10a_Statistical Consult Agenda.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 9_ 2011 HIV Sec Conf Guidlines.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 8b_ Security Statement.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 7c_2012 CSTE Pre Conf Mtg Agenda.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 7b_2011 HIV Workshop Agenda.pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 3c_eHARS Variables (2).pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 3f_CRF Changes.docx	Supplementary Document	Uploaded 2012-12-19	Available
Final Att-4d MHS Tech Guidance (2).pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att 6_ 2010 HIV Surv Report.pdf	Supplementary Document	Uploaded 2012-12-19	Available
0920-0573_att 4(b)Technical_Guidance_HIV Incidence Surveillance.pdf	Supplementary Document	Uploaded 2009-11-30	Available
Final Att-4b Peds Tech Guidance Vol 2 (2).pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Att-4a Adult Tech Guidance Vol 2 (2).pdf	Supplementary Document	Uploaded 2012-12-19	Repair queued
Final Att 3c_eHARS Variables (2).pdf	Supplementary Document	Uploaded 2012-12-19	Available
Final Rev corr SS A.docx	Supporting Statement A	Uploaded 2013-02-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7028	Adult HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged	Adult HIV Confidential Case Report Form
46035	Perinatal HIV Exposure Reporting (PHER)	Form	Modified	PHER (mondfied)
46034	HIV Incidence Surveillance (HIS)	Form and Instruction	Unchanged	Final Att 4c_Incidence TG append (2)
46032	Case Report Updates	Form and Instruction	Unchanged	Final Att-3a Adult CRF (2)
46032	Case Report Updates	Form	Unchanged	Pediatric HIV/AIDS Confidential Case Report
46030	Pediatric HIV/AIDS Confidential Case Report	Form	Unchanged	Pediatric HIV Confidential Case Report Form
205250	Molecular HIV Surveillance (MHS)	Form and Instruction	Unchanged	Final Att 3d_MHS data elements (2)
205249	Laboratory Updates	Form and Instruction	Unchanged	Final Att 5_2009-2012 Publications
205248	Case Report Evaluation	Instruction	Unchanged

ICR Details

OMB Control No: 0920-0573	ICR Reference No: 201409-0920-005
Status: Historical Active	Previous ICR Reference No: 201301-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 14AYH
Title: National HIV Surveillance System (NHSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/23/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/12/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	02/29/2016	02/29/2016
Responses	639,008	0	639,008
Time Burden (Hours)	53,700	0	53,700
Cost Burden (Dollars)	0	0	0

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Abstract: After receiving input from state and local HIV surveillance coordinators that modifications would be useful to both ease data collection and allow for better collection of antiretroviral treatment variables, we are requesting minor changes to the Perinatal HIV Exposure Report (PHER) form.

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Authorizing Statute(s): US Code: 42 USC 242m Name of Law: General Provisions Respecting Effectiveness, Efficiency, and Quality of Health Services
   US Code: 42 USC 242k Name of Law: National Center for Health Statistics
   US Code: 42 USC 242b Name of Law: General Authority Respecting Research...
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 47848	08/10/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 76045	12/26/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Adult HIV/AIDS Confidential Case Report	0920-0573	Adult HIV Confidential Case Report Form
Case Report Evaluation
Case Report Updates	none, 0920-0573	Pediatric HIV/AIDS Confidential Case Report ,   Final Att-3a Adult CRF (2)
HIV Incidence Surveillance (HIS)	0920-0573	Final Att 4c_Incidence TG append (2)
Laboratory Updates	0920-0573	Final Att 5_2009-2012 Publications
Molecular HIV Surveillance (MHS)	0920-0573	Final Att 3d_MHS data elements (2)
Pediatric HIV/AIDS Confidential Case Report	0920-0573	Pediatric HIV Confidential Case Report Form
Perinatal HIV Exposure Reporting (PHER)	none	PHER (mondfied)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	639,008	639,008	0	0	0	0
Annual Time Burden (Hours)	53,700	53,700	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $68,792,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/12/2014

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