OMB
.report
Search
Cluster Follow-up Report
National HIV Surveillance System (NHSS)
OMB: 0920-0573
IC ID: 236511
OMB.report
HHS/CDC
OMB 0920-0573
ICR 202008-0920-010
IC 236511
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:
2024-08-06 - No material or nonsubstantive change to a currently approved collection
2023-10-17 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Cluster Follow-up Report
Form and Instruction
Cluster Follow-up Form
Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.pdf
Form and Instruction
Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf
Instructions: Cluster Investigation Reporting
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Cluster Follow-up Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Cluster Follow-up Form
Att 3g_ Cluster Follow Up Form_rev18Jun19pdf.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 62812
Number of Respondents:
59
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
295
0
0
0
0
295
Annual IC Time Burden (Hours)
148
0
0
0
0
148
Annual IC Cost Burden (Dollars)
3,983
0
0
0
0
3,983
Documents for IC
Title
Document
Date Uploaded
Instructions: Cluster Investigation Reporting
Att 4f_Cluster Investigation Report Form Instructions 9.10.1.pdf
06/26/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.