Objectives 1 and 2 Risk Factor Assessment

Characterization of risk of HIV and HIV outcomes in the Brazilian Sickle Cell Disease (SCD) population and comparison of SCD outcomes between HIV sero-positive and negative SCD patients

Documents and Forms

Document Name Document Type
Form 3 Objectives 1 and 2 Risk Factor Assessment Form and Instruction
3 Brazil SCD Rick Factor Assessment Attachment_1_Brazil_SCD_Risk_Factor_Assessment_3_2016_V_7.0.docx Form and Instruction
Attachment_5_Risk_Factor_Assessment_Portuguese_7_21_2015_V_3.0.docx Attachment 5 Risk Factor Assessment Portuguese IC Document

Information Collection (IC) Details

IC Title:	Objectives 1 and 2 Risk Factor Assessment	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	3	Brazil SCD Rick Factor Assessment	Attachment_1_Brazil_SCD_Risk_Factor_Assessment_3_2016_V_7.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 325	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	325	325
Annual IC Time Burden (Hours)	244	244
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 5 Risk Factor Assessment Portuguese	Attachment_5_Risk_Factor_Assessment_Portuguese_7_21_2015_V_3.0.docx	09/22/2015

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