HIV Testing Form

Co-location and Integration of HIV Prevention and Medical Care into Behavioral Health Program

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.