Information Collection

HIV Quality Measures Performance Measure Module (HIVQM Module)

IC 222138 under ICR 201909-0906-002 · OMB 0906-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0022 can be found here:

Documents and Forms

Document Name Document Type
Form 1 HIV Quality Measures Performance Measure Module (HIVQM Module) Form
1 Draft Manual Draft Manual_reviewed.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIV Quality Measures Performance Measure Module (HIVQM Module)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Draft Manual	Draft Manual_reviewed.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,316	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,264	2,316	6,948
Annual IC Time Burden (Hours)	55,584	48,636	6,948
Annual IC Cost Burden (Dollars)	0	0	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.