Information Collection

HIV Testing Form

IC 212075 under ICR 201510-0930-003 · OMB 0930-0343.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RHHT Testing Form HIV Testing Form	Form and Instruction
RHHT Testing Form RHHT Testing Form Attachment 2. RHHT Testing Form 10.14.2015.pdf	Form and Instruction
Attachment 1. Highlighted changes to the RHHT Form 10.14.2015.pdf Highlighted changes to the RHHT Form	IC Document

IC Title:

HIV Testing Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	RHHT Testing Form	RHHT Testing Form	Attachment 2. RHHT Testing Form 10.14.2015.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 46,900

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	46,900	41,900	5,000
Annual IC Time Burden (Hours)	6,097	5,447	650
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Highlighted changes to the RHHT Form	Attachment 1. Highlighted changes to the RHHT Form 10.14.2015.pdf	10/14/2015

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