Community-Based Organization Report - NHME

National HIV Prevention Program Monitoring and Evaluation (NHM&E)

Documents and Forms

Document Name Document Type
Att 5A NHME Variables July 2018.pdf Other-Data Elements
Att 5A NHME Variables July 2018.pdf Other-Data Elements
Att 5A NHME Variables.pdf Other-Data Elements
Att 5A NHME Variables.pdf Other-Data Elements
Att 5B NHME Variables Options July 2018.docx Data Variable Options IC Document
Att 5B NHME Variables Options July 2018.docx Data Variable Options IC Document

Information Collection (IC) Details

IC Title:	Community-Based Organization Report - NHME	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Data Elements			Att 5A NHME Variables July 2018.pdf		Yes	Yes	Fillable Printable
Other-Data Elements			Att 5A NHME Variables.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	16,200	16,200
Annual IC Cost Burden (Dollars)	313,632	313,632

Documents for IC

Title	Document	Date Uploaded
Data Variable Options	Att 5B NHME Variables Options July 2018.docx	08/20/2018

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