Perinatal HIV Exposure Reporting (PHER)

National HIV Surveillance System (NHSS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Document Name Document Type
Perinatal HIV Exposure Reporting (PHER) Form and Instruction
Perinatal HIV Exposure Reporting Form Att 3d_Perinatal HIV Exposure Reporting Form 2019_v1_OMB_rev18Jun19.pdf Form and Instruction
Att 4b_PEDIATRIC HIV AND PERINATAL EXPOSURE CONFIDENTIAL CASE REPORT FORM_TG..pdf Technical Guidance: Pediatric HIV Case Reporting and Perinatal HIV Exposure Reporting IC Document

Information Collection (IC) Details

IC Title:	Perinatal HIV Exposure Reporting (PHER)	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	Perinatal HIV Exposure Reporting Form	Att 3d_Perinatal HIV Exposure Reporting Form 2019_v1_OMB_rev18Jun19.pdf		Yes	Yes	Fillable Fileable

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 61812

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,152	3,152
Annual IC Time Burden (Hours)	1,576	1,576
Annual IC Cost Burden (Dollars)	42,552	42,552

Documents for IC

Title	Document	Date Uploaded
Technical Guidance: Pediatric HIV Case Reporting and Perinatal HIV Exposure Reporting	Att 4b_PEDIATRIC HIV AND PERINATAL EXPOSURE CONFIDENTIAL CASE REPORT FORM_TG..pdf	06/26/2019

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