Cluster Follow-up Report

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⚠️ Notice: This information collection may be referencing outdated material.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
Cluster Follow-up Report Form and Instruction
Cluster Follow-up Form Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.pdf Form and Instruction
Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf Instructions: Cluster Investigation Reporting IC Document

Information Collection (IC) Details

IC Title:	Cluster Follow-up Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Cluster Follow-up Form	Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.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
Annual Number of Responses for this IC	295	295
Annual IC Time Burden (Hours)	148	148
Annual IC Cost Burden (Dollars)	3,983	3,983

Documents for IC

Title	Document	Date Uploaded
Instructions: Cluster Investigation Reporting	Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf	06/26/2019

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