HIV Quality Measures Performance Measure Module (HIVQM Module)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0022 can be found here:

Documents and Forms

Document Name Document Type
Form B HIV Quality Measures Performance Measure Module (HIVQM Module) Form
HIVQM Manual PASSBACK FINAL 12-16.docx Instruction
HIVQM mock up PBS OMB control and expiration.pdf Instruction
B Draft HIVQM Manual B 2016 DRAFT HIVQM Manual.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIV Quality Measures Performance Measure Module (HIVQM Module)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	B	Draft HIVQM Manual	B 2016 DRAFT HIVQM Manual.docx	Yes	Yes	Fillable Fileable
Instruction			HIVQM mock up PBS OMB control and expiration.pdf	Yes	Yes	Fillable Fileable
Instruction			HIVQM Manual PASSBACK FINAL 12-16.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,316	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	6,948	6,948
Annual IC Time Burden (Hours)	6,948	6,948
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.