Case Report Updates

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 46032

Information Collection (IC) Details

View Information Collection (IC)

Case Report Updates
 
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 Adult HIV Case Report Form Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf Yes Yes Fillable Fileable
Form and Instruction n/a Pediatric HIV Case Report Form Att 3b_Pediatric Case Report Form 2019_v4_OMB_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 138,827 0 0 0 0 138,827
Annual IC Time Burden (Hours) 4,628 0 0 0 0 4,628
Annual IC Cost Burden (Dollars) 124,944 0 0 0 0 124,944

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: Adult HIV Case Report Form Att 4a_ADULT HIV CONFIDENTIAL CASE REPORT FORM_20181101_TG.pdf 06/26/2019
Technical Guidance: Pediatric HIV Case Report Form 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.

© 2024 OMB.report | Privacy Policy