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Adult HIV/AIDS Confidential Case Report
National HIV Surveillance System (NHSS)
OMB: 0920-0573
IC ID: 7028
OMB.report
HHS/CDC
OMB 0920-0573
ICR 202008-0920-010
IC 7028
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Adult HIV/AIDS Confidential Case Report
Form and Instruction
Adult Case Report Form
Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf
Form and Instruction
Att 3c_NHSS_dataelements OMB_20190313_clean.pdf
Reference: Data Elements for the National HIV Surveillance System
IC Document
Att 4c_TECHNICAL GUIDANCE DUPLICATE REVIEW FINAL.pdf
Technical Guidance: Duplicate Review
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Adult HIV/AIDS Confidential Case 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
Adult Case Report Form
Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.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
50,386
0
0
0
0
50,386
Annual IC Time Burden (Hours)
16,795
0
0
0
0
16,795
Annual IC Cost Burden (Dollars)
453,474
0
0
0
0
453,474
Documents for IC
Title
Document
Date Uploaded
Reference: Data Elements for the National HIV Surveillance System
Att 3c_NHSS_dataelements OMB_20190313_clean.pdf
06/26/2019
Technical Guidance: Duplicate Review
Att 4c_TECHNICAL GUIDANCE DUPLICATE REVIEW FINAL.pdf
06/26/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.