HIV Testing Retrospective Reporting Tool

Quarterly Progress Reporting and Annual Indirect Services Outcome Data Collection for the Minority Substance Abuse/HIV Prevention Program (MAI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0357 can be found here:

Documents and Forms

Document Name Document Type
Form HIV Testing Retros HIV Testing Retrospective Reporting Tool Form and Instruction
HIV Testing Retros HIV Testing Retrospective Reporting Tool Attachment 3-Retrospective_HIV_Testing.151027.docx Form and Instruction

Information Collection (IC) Details

IC Title:	HIV Testing Retrospective Reporting Tool	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	HIV Testing Retrospective Reporting Tool	HIV Testing Retrospective Reporting Tool	Attachment 3-Retrospective_HIV_Testing.151027.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	4	4
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.