Information Collection

National ART Surveillance System

IC 43614 under ICR 201705-0920-009 · OMB 0920-0556.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0556 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form C1b_v2 National ART Surveillance System	Form
C1b_v2 Att C1b v2 (Proposed) Future NASS screens for 2016 Att C1b v2 (Proposed) Future NASS screens for 2016_09 04 2015.docx	Form
C1b_v3 National ART Surveillance System NASS 2.) (Proposed for Att. C1b_v3 (Proposed) Future NASS screens for 2017.docx	Form
C1b_v3 Att C1b_v3 NASS screens Att C1b_v3 NASS screens.docx	Form and Instruction
C1b_v4 Att C1b_v4 NASS screens_04_17_2017_clean Att C1b_v4 NASS screens_04_17_2017_clean.docx	Form and Instruction
Att C2. (Current) NASS Annual Submission Instructions.doc NASS Instructions	IC Document
Att C3. (Current) NASS Users Manual.pdf NASS User manual	IC Document
Att C1b_v4 NASS screens_04_17_2017_changes highlighted.docx Att C1b_v4 NASS screens_04_17_2017_changes highlighted	IC Document
OMB 0920-0556_change request 05.4.17.docx OMB 0920-0556_change request 05.4.17	IC Document

IC Title:

National ART Surveillance System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	C1b_v2	Att C1b v2 (Proposed) Future NASS screens for 2016	Att C1b v2 (Proposed) Future NASS screens for 2016_09 04 2015.docx	Yes	Yes	Fillable Fileable
Form	C1b_v3	National ART Surveillance System NASS 2.) (Proposed for 2016)	Att. C1b_v3 (Proposed) Future NASS screens for 2017.docx	Yes	Yes	Fillable Printable
Form and Instruction	C1b_v3	Att C1b_v3 NASS screens	Att C1b_v3 NASS screens.docx	Yes	Yes	Fillable Fileable
Form and Instruction	C1b_v4	Att C1b_v4 NASS screens_04_17_2017_clean	Att C1b_v4 NASS screens_04_17_2017_clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 447

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	157,791	0	157,791
Annual IC Time Burden (Hours)	111,769	1,315	110,454
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NASS Instructions	Att C2. (Current) NASS Annual Submission Instructions.doc	02/12/2015
NASS User manual	Att C3. (Current) NASS Users Manual.pdf	02/12/2015
Att C1b_v4 NASS screens_04_17_2017_changes highlighted	Att C1b_v4 NASS screens_04_17_2017_changes highlighted.docx	05/16/2017
OMB 0920-0556_change request 05.4.17	OMB 0920-0556_change request 05.4.17.docx	05/16/2017

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