Information Collection

HIV Risk Factor

IC 187040 under ICR 201411-0925-001 · OMB 0925-0596.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 HIV Risk Factor	Form and Instruction
1.1 HIV Attachment 1 1_HIV Qx.doc	Form and Instruction
Attachment 2.1_Consent Cases HIV.doc Attachment 2	IC Document
Attachment 2.2_Consent Controls HIV.doc Attachment 2	IC Document

IC Title:

HIV Risk Factor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	1.1	HIV	Attachment 1 1_HIV Qx.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,050

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,050	1,050
Annual IC Time Burden (Hours)	-347	347
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2	Attachment 2.1_Consent Cases HIV.doc	10/22/2008
Attachment 2	Attachment 2.2_Consent Controls HIV.doc	10/22/2008

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