Annual Reporting: Standards Evaluation Report (SER)

National HIV Surveillance System (NHSS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Document Name Document Type
Annual Reporting: Standards Evaluation Report (SER) Form and Instruction
Standards Evaluation Report Form (Years 2-5) Att 3e_SER PS18-1802 OMB Yrs 2-5 Form v3_rev18Jun19.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Reporting: Standards Evaluation Report (SER)	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	n/a	Standards Evaluation Report Form (Years 2-5)	Att 3e_SER PS18-1802 OMB Yrs 2-5 Form v3_rev18Jun19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC	FR Citation: 57 FR 62812

Number of Respondents: 59	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	Previously Approved
Annual Number of Responses for this IC	59	0	59
Annual IC Time Burden (Hours)	472	0	472
Annual IC Cost Burden (Dollars)	12,744	12,744	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.