Information Collection

Brazil HIV Case Study Questionnaire

IC 215854 under ICR 201503-0925-008 · OMB 0925-0597.

Documents and Forms

Document Name Document Type
Form 2 Brazil HIV Case Study Questionnaire Form and Instruction
Attach_5_Risk_Factor_Assessment_Portuguese_2_2105_V_3.0.docx Other-Portuguese Assessment Question
2 REDS-III Risk Factor Assessment Attach_1_REDS-III_Risk_Factor_Assessment_2_2015_V_3.0.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Brazil HIV Case Study Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	2	REDS-III Risk Factor Assessment	Attach_1_REDS-III_Risk_Factor_Assessment_2_2015_V_3.0.docx		Yes	Yes	Fillable Fileable
Other-Portuguese Assessment Questionnaire			Attach_5_Risk_Factor_Assessment_Portuguese_2_2105_V_3.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.