Information Collection

HIV registry matching

IC 241635 under ICR 202004-0920-024 · OMB 0920-1072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att5_DataElements_DataDisctionary.pdf	Other-HIV Registry

IC Title:

HIV registry matching

Agency IC Tracking Number:

0920-1072

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HIV Registry					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11	11
Annual IC Time Burden (Hours)	880	880
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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