Pediatric HIV/AIDS Confidential Case Report

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 46030

Information Collection (IC) Details

View Information Collection (IC)

Pediatric HIV/AIDS Confidential Case Report
 
No Modified
 
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 n/a Pediatric Case Report Form Att 3b_Pediatric Case Report Form 2019_v4_OMB_rev18Jun19.pdf 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 177 0 -118 0 0 295
Annual IC Time Burden (Hours) 59 0 -39 0 0 98
Annual IC Cost Burden (Dollars) 1,593 0 1,593 0 0 0

Title Document Date Uploaded
Reference: Data Elements for the National HIV Surveillance System Att 3c_NHSS_dataelements OMB_20190313_clean.pdf 06/26/2019
Technical Guidance: Pediatric Case Report and Perinatal HIV Exposure Report Att 4b_PEDIATRIC HIV AND PERINATAL EXPOSURE CONFIDENTIAL CASE REPORT FORM_TG..pdf 06/26/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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