Information Collection

HIV Surveillance Data System Needs and IT Capability Assessment

IC 244939 under ICR 202005-0920-010 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HIV Surveillance Data System Needs and IT Capability Assessment	Form and Instruction
HIV Surveillance System and IT Capability Survey Questions_HIV Surveillance Data System Needs and IT Capability_20201216.docx	Form and Instruction
Generic Clearance_HIV Surveillance Data System Needs and IT Capability Assessment.docx GENIC Template with Project Description	IC Document

IC Title:

HIV Surveillance Data System Needs and IT Capability Assessment

Agency IC Tracking Number:

0920-21BP

IC Status: New

Obligation to Respond: Voluntary

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
Form and Instruction	n/a	HIV Surveillance System and IT Capability Survey	Questions_HIV Surveillance Data System Needs and IT Capability_20201216.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

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	59	59
Annual IC Time Burden (Hours)	118	118
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GENIC Template with Project Description	Generic Clearance_HIV Surveillance Data System Needs and IT Capability Assessment.docx	12/18/2020

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