Perinatal HIV Exposure Reporting (PHER)

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⚠️ Notice: This information collection may be referencing outdated material.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
Perinatal HIV Exposure Reporting (PHER) Form and Instruction
Perinatal HIV Exposure Reporting Form Att 3d_Perinatal HIV Exposure Reporting Form 2019_v1_OMB_rev18Jun19.pdf Form and Instruction
Att 4b_PEDIATRIC HIV AND PERINATAL EXPOSURE CONFIDENTIAL CASE REPORT FORM_TG..pdf Technical Guidance: Pediatric HIV Case Reporting and Perinatal HIV Exposure Reporting IC Document

Information Collection (IC) Details

IC Title:	Perinatal HIV Exposure Reporting (PHER)	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	Perinatal HIV Exposure Reporting Form	Att 3d_Perinatal HIV Exposure Reporting Form 2019_v1_OMB_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 61812

Number of Respondents: 16	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	3,152	-838	3,990
Annual IC Time Burden (Hours)	1,576	-419	1,995
Annual IC Cost Burden (Dollars)	42,552	42,552	0

Documents for IC

Title	Document	Date Uploaded
Technical Guidance: Pediatric HIV Case Reporting and Perinatal HIV Exposure Reporting	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.