Adult HIV/AIDS Confidential Case Report

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 7028

Information Collection (IC) Details

View Information Collection (IC)

Adult HIV/AIDS Confidential Case 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 Adult Case Report Form Att 3a_Adult 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 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

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.

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