Case Report Evaluations

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 205248

Information Collection (IC) Details

View Information Collection (IC)

Case Report Evaluations
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Adult HIV Confidential Case Report Form 2015 Att 3a_ACRF_PROOF242015.pdf NA Yes Yes Fillable Fileable
Instruction Att_3c_NHSS_dataelements OMB 21Dec2015.pdf NA Yes Yes Fillable Fileable
Form and Instruction NA Pediatric HIV Confidential Case Report Form Att 3b_PCRF_PROOF112015.pdf NA Yes Yes Fillable Fileable

Health Public Health Monitoring

Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC  57 FR 62812

59 0
   
State, Local, and Tribal Governments
 
   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 6,313 0 0 0 0 6,313
Annual IC Time Burden (Hours) 2,104 0 0 0 0 2,104
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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