National HIV Surveillance System (NHSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Adult Case Report Form	Form and Instruction	Unchanged	Available
Perinatal HIV Exposure Reporting Form	Form and Instruction	Unchanged	Available
Pediatric HIV Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV Case Report Form	Form and Instruction	Unchanged	Available
Pediatric Case Report Form	Form and Instruction	Unchanged	Available
Form 0920-0573 HIV Incidence Surveillance (HIS)	Form and Instruction	New	Available
Cluster Close-out Form	Form and Instruction	Unchanged	Available
Cluster Follow-up Form	Form and Instruction	Unchanged	Available
Initial Cluster Report Form	Form and Instruction	Unchanged	Available
Standards Evaluation Report Form (Years 2-5)	Form and Instruction	Unchanged	Available
Pediatric HIV Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV Case Report Form	Form and Instruction	Unchanged	Available
Pediatric HIV Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV Case Report Form	Form and Instruction	Unchanged	Available
Justification for Change for 0920-0573_NHSS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-08-28	Available
Att10_ Summary of Changes_incidence_14Aug20 (1).docx	Supplementary Document	Uploaded 2020-08-20	Available
Att 10_ Summary of Changes_18Jun19_clean.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 9_Project Determination.pdf	Supplementary Document	Uploaded 2019-06-26	Available
SSB_3Jun19_clean.docx	Supporting Statement B	Uploaded 2019-06-26	Available
SSA_25Jun19_clean_rev14Aug20.docx	Supporting Statement A	Uploaded 2020-08-28	Available
Att 8_Data Security and Confidentiality Guidelines.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 7b_HIV Surveillance Confidentiality Security Statement and Data Access Packet.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 7a_Assurance of Confidentiality for HIV Surveillance.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 6b_eHARS ATO_2019.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 6a_eHARS PIA_2019.pdf	Supplementary Document	Uploaded 2019-06-26	Repair queued
Att 5_cdc-hiv-surveillance-report-2017-vol-29.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 2_ 60 Day FRN_0920-0573.pdf	Supplementary Document	Uploaded 2019-06-26	Available
Att 1_ Authorizing Legislation.pdf	Supplementary Document	Uploaded 2019-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7028	Adult HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged	Adult Case Report Form
46035	Perinatal HIV Exposure Reporting (PHER)	Form and Instruction	Unchanged	Perinatal HIV Exposure Reporting Form
46032	Case Report Updates	Form and Instruction	Unchanged	Pediatric HIV Case Report Form
46032	Case Report Updates	Form and Instruction	Unchanged	Adult HIV Case Report Form
46030	Pediatric HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged	Pediatric Case Report Form
243727	HIV Incidence Surveillance (HIS)	Form and Instruction	New	HIV Incidence Surveillance (HIS)
236513	Data De-duplication Activities	Other-Technical Guidance for Data Management: Duplicate Review	Unchanged
236512	Cluster Close-out Report	Form and Instruction	Unchanged	Cluster Close-out Form
236511	Cluster Follow-up Report	Form and Instruction	Unchanged	Cluster Follow-up Form
236510	Initial Cluster Report	Form and Instruction	Unchanged	Initial Cluster Report Form
236509	Investigation Reporting and Evaluation	Other-Reporting Guidance: Data-to-Care	Unchanged
220109	Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction	Unchanged	Standards Evaluation Report Form (Years 2-5)
205249	Laboratory Updates	Form and Instruction	Unchanged	Pediatric HIV Case Report Form
205249	Laboratory Updates	Form and Instruction	Unchanged	Adult HIV Case Report Form
205248	Case Report Evaluations	Form and Instruction	Unchanged	Pediatric HIV Case Report Form
205248	Case Report Evaluations	Form and Instruction	Unchanged	Adult HIV Case Report Form

ICR Details

OMB Control No: 0920-0573	ICR Reference No: 202008-0920-010
Status: Historical Active	Previous ICR Reference No: 201906-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0573-20RP
Title: National HIV Surveillance System (NHSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/22/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	11/30/2022	11/30/2022
Responses	984,308	0	968,334
Time Burden (Hours)	59,462	0	58,131
Cost Burden (Dollars)	1,713,290	0	1,569,524

---

Abstract: CDC in collaboration with state and local health departments in the 50 states, the District of Columbia, and U.S. dependent areas, conducts national surveillance for cases of HIV infection that provides critical data across the spectrum of HIV disease from HIV diagnosis, to AIDS, the end-stage disease caused by infection with HIV, and death. HIV surveillance data are used to monitor the extent and characteristics of the HIV burden in the United States. In addition, this national system provides essential data to estimate HIV incidence and monitor patterns in HIV drug resistance and genetic diversity, detect HIV clusters, and perinatal exposures.

---

Authorizing Statute(s): US Code: 42 USC 242b Name of Law: General Authority Respecting Research...
   US Code: 42 USC 247c Name of Law: Sexually Transmitted Diseases; Prevention and Control Projects and Programs
   US Code: 42 USC 247b Name of Law: Project Grants for Preventive Health Services
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 16868	04/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 30118	06/26/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Adult HIV/AIDS Confidential Case Report	n/a	Adult Case Report Form
Annual Reporting: Standards Evaluation Report (SER)	n/a	Standards Evaluation Report Form (Years 2-5)
Case Report Evaluations	n/a, n/a	Adult HIV Case Report Form ,   Pediatric HIV Case Report Form
Case Report Updates	n/a, n/a	Adult HIV Case Report Form ,   Pediatric HIV Case Report Form
Cluster Close-out Report	n/a	Cluster Close-out Form
Cluster Follow-up Report	n/a	Cluster Follow-up Form
Data De-duplication Activities
HIV Incidence Surveillance (HIS)	0920-0573	HIV Incidence Surveillance (HIS)
Initial Cluster Report	n/a	Initial Cluster Report Form
Investigation Reporting and Evaluation
Laboratory Updates	n/a, n/a	Adult HIV Case Report Form ,   Pediatric HIV Case Report Form
Pediatric HIV/AIDS Confidential Case Report	n/a	Pediatric Case Report Form
Perinatal HIV Exposure Reporting (PHER)	n/a	Perinatal HIV Exposure Reporting Form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	984,308	968,334	0	0	15,974	0
Annual Time Burden (Hours)	59,462	58,131	0	0	1,331	0
Annual Cost Burden (Dollars)	1,713,290	1,569,524	0	0	143,766	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $66,870,415

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/28/2020

---