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HIV Case Control Study
The Prevalence and Incidence of HIV Molecular Variants and Their Correlation with Risk Behaviors and HIV Treatment in Brazilian Blood Donors (NHLBI)
OMB: 0925-0597
IC ID: 187011
OMB.report
HHS/NIH
OMB 0925-0597
ICR 201503-0925-008
IC 187011
( )
Documents and Forms
Document Name
Document Type
Form 1
HIV Case Control Study
Form and Instruction
1 Questionnaire
Attach_1_Brazil_HIV_Case_Study_Questionnaire_4_26_2012_V_7 0.docx
Form and Instruction
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2.0.docx
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2
IC Document
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0.docx
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0
IC Document
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1.0.docx
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HIV Case Control Study
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
Form and Instruction
1
Questionnaire
Attach_1_Brazil_HIV_Case_Study_Questionnaire_4_26_2012_V_7 0.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
0
0
-100
0
0
100
Annual IC Time Burden (Hours)
0
0
-40
0
0
40
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2
Attach_2_Brazil_HIV_Informed Consent_4_2012_V_2.0.docx
04/30/2012
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0
Attach_6_Brazil_HIV_Case_Study_Questionnaire_Portuguese_4_2102_V_1 0.docx
04/30/2012
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1
Attach_7_ Brazil_HIV_Informed_Consent_Portuguese_4_2120_V_1.0.docx
04/30/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.