Cluster Close-out Report

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 236512

Information Collection (IC) Details

View Information Collection (IC)

Cluster Close-out Report
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Cluster Close-out Form Att 3h _Cluster Closeout Form_rev18Jun19.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC  57 FR 62812

59 0
   
State, Local, and Tribal Governments
 
   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 148 0 0 0 0 148
Annual IC Time Burden (Hours) 148 0 0 0 0 148
Annual IC Cost Burden (Dollars) 3,996 0 0 0 0 3,996

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.

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