Community-Based Organization Report - NHME

National HIV Prevention Program Monitoring and Evaluation (NHM&E)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0696 can be found here:

Documents and Forms

Document Name Document Type
Att 5A NHME Variables July 2018.pdf Other-Data Elements
Att 5B NHME Variables Options July 2018.docx Data Variable Options IC Document

Information Collection (IC) Details

IC Title:	Community-Based Organization 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
Other-Data Elements			Att 5A NHME Variables July 2018.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	-100	400
Annual IC Time Burden (Hours)	16,200	0	16,200
Annual IC Cost Burden (Dollars)	313,632	313,632	0

Documents for IC

Title	Document	Date Uploaded
Data Variable Options	Att 5B NHME Variables Options July 2018.docx	08/20/2018

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