OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Qualitative Investigation of HIV Transmission in Southeastern Indiana, 2015

IC 217928 under ICR 201601-0920-017 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HIV Risk Factors Interview Guide Qualitative Investigation of HIV Transmission in Southeastern Indiana, 2015	Form and Instruction
HIV Risk Factors Interview Guide Appendix 1_Interview Guide.doc	Form and Instruction
2015012-XXX HIV_IN.docx EEI Request for Approval_HIV Indiana	IC Document
CDC IRB_6776 New Approval.docx IRB Approval - CDC	IC Document
0920-1011 GenIC Request HIV_Indiana Burden Table.msg GenIC Request - Burden Table	IC Document
LOI.pdf Letter of Invitation	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Qualitative Investigation of HIV Transmission in Southeastern Indiana, 2015

Agency IC Tracking Number:

IC Status: Unchanged

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	NA			NA	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 Epidemic Investigation Case Records

FR Citation: 51 FR 42466

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	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	30	0	0	0	0	30
Annual IC Time Burden (Hours)	45	0	0	0	0	45
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
EEI Request for Approval_HIV Indiana		08/21/2015
IRB Approval - CDC		08/21/2015
GenIC Request - Burden Table		08/21/2015
Letter of Invitation		08/21/2015

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

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