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Health Department Report - NHME
National HIV Prevention Program Monitoring and Evaluation (NHM&E)
OMB: 0920-0696
IC ID: 217850
OMB.report
HHS/CDC
OMB 0920-0696
ICR 201805-0920-002
IC 217850
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0696 can be found here:
2021-05-14 - Revision of a currently approved collection
2018-09-18 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0696
Health Department Report - NHME
Form and Instruction
0920-0696 NHME Data Variables and Values
Attachment D. Proposed 2018 NHME Data Variable Set (DVS) 0902-0696 May 2018.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Department Report - NHME
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
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
0920-0696
NHME Data Variables and Values
Attachment D. Proposed 2018 NHME Data Variable Set (DVS) 0902-0696 May 2018.pdf
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
69
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 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
138
0
0
0
0
138
Annual IC Time Burden (Hours)
190,026
0
0
0
0
190,026
Annual IC Cost Burden (Dollars)
0
0
0
0
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.