Information Collection Request

National HIV Surveillance System (NHSS)

ICR 202208-0920-013 · OMB 0920-0573 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Adult HIV Confidential Case Report Form Form and Instruction Modified Repair queued
Adult HIV/AIDS Confidential Case Report Form and Instruction Modified Repair queued
Perinatal HIV Exposure Reporting Form Form and Instruction Removed Available
Perinatal HIV Exposure Reporting (PHER) Form and Instruction Removed Repair queued
Pediatric HIV Confidential Case Report Form Form and Instruction Modified Available
Adult HIV Confidential Case Report Form Form and Instruction Modified Available
Case Report Updates Form and Instruction Modified Repair queued
Pediatric HIV Confidential Case Report Form Form and Instruction Modified Repair queued
Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) Form and Instruction Modified Repair queued
Form 0920-0573 HIV Incidence Surveillance (HIS) Form and Instruction Removed Available
Form 0920-0573 HIV Incidence Surveillance (HIS) Form and Instruction Removed Repair queued
Cluster Close-out Form Form and Instruction Modified Available
Cluster Close-out Report Form and Instruction Modified Repair queued
Cluster Follow-up Form Form and Instruction Modified Available
Cluster Follow-up Report Form and Instruction Modified Repair queued
Initial Cluster Report Form Form and Instruction Modified Available
Initial Cluster Report Form and Instruction Modified Repair queued
2023 Standards Evaluation Report (SER) Form and Instruction Modified Available
Annual Reporting: Standards Evaluation Report (SER) Form and Instruction Modified Repair queued
Pediatric HIV Confidential Case Report Form Form and Instruction Modified Available
Adult HIV Confidential Case Report Form Form and Instruction Modified Available
Laboratory Updates Form and Instruction Modified Repair queued
Pediatric HIV Confidential Case Report Form Form and Instruction Modified Repair queued
Adult HIV Confidential Case Report Form Form and Instruction Modified Repair queued
Case Report Evaluations Form and Instruction Modified Repair queued
Att_10 Summary of Changes FINAL_08Feb22_SERv3_PWID _update_clean.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_9_Project Determination.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_8_Data Security and Confidentiality Guidelines.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_7(b) NHSS_ Complete AoC_Final updated 102621 per amendment_CSpacket.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_7(a) NHSS_ AoC Statement_FinalOct2019.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_6(b) ATO.pdf Supplementary Document Uploaded 2022-09-08 Available
Att_6(a) PIA.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_5 cdc-hiv-surveillance-report-2020-updated-vol-33.pdf Supplementary Document Uploaded 2022-09-08 Available
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_4(e) DETECTING HIV TRANSMISSION CLUSTERS 2022 v1 (1).pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_4(d) D2C-Monitoring-and-Evaluation-Guidance _Jun21fin_508C_8.30.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_4(c) DUPLICATE REVIEW 2022 v1.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_4(b) PEDIATRIC HIV CASE REPORT FORM 2023 v2_PWID edit_clean.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_4(a) ADULT HIV CONFIDENTIAL CASE REPORT FORM 2023 v2.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_3(c) NHSS_dataelements_OMB_BG_KB_Clean_PWID edit_clean.pdf Supplementary Document Uploaded 2022-09-08 Repair queued
Att_2(a) 60 Day FRN pub 4 -1-2022.pdf Supplementary Document Uploaded 2022-09-07 Repair queued
Att_1_ Authorizing Legislation.pdf Supplementary Document Uploaded 2022-09-07 Repair queued
SSB_08Aug22_clean.docx Supporting Statement B Uploaded 2022-09-07 Repair queued
SSA_NHSS_31AUG22_clean.docx Supporting Statement A Uploaded 2022-09-07 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
7028 Adult HIV/AIDS Confidential Case Report Form and Instruction ModifiedAdult HIV Confidential Case Report Form
7028 Adult HIV/AIDS Confidential Case Report Form and Instruction Modified
46035 Perinatal HIV Exposure Reporting (PHER) Form and Instruction RemovedPerinatal HIV Exposure Reporting Form
46035 Perinatal HIV Exposure Reporting (PHER) Form and Instruction Removed
46032 Case Report Updates Form and Instruction ModifiedPediatric HIV Confidential Case Report Form
46032 Case Report Updates Form and Instruction ModifiedAdult HIV Confidential Case Report Form
46032 Case Report Updates Form and Instruction Modified
46030 Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) Form and Instruction ModifiedPediatric HIV Confidential Case Report Form
46030 Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) Form and Instruction Modified
243727 HIV Incidence Surveillance (HIS) Form and Instruction RemovedHIV Incidence Surveillance (HIS)
243727 HIV Incidence Surveillance (HIS) Form and Instruction Removed
236513 Data De-duplication Activities Other-Technical Guidance for HIV Surveillance Programs: Duplicat Modified
236512 Cluster Close-out Report Form and Instruction ModifiedCluster Close-out Form
236512 Cluster Close-out Report Form and Instruction Modified
236511 Cluster Follow-up Report Form and Instruction ModifiedCluster Follow-up Form
236511 Cluster Follow-up Report Form and Instruction Modified
236510 Initial Cluster Report Form and Instruction ModifiedInitial Cluster Report Form
236510 Initial Cluster Report Form and Instruction Modified
236509 Investigation Reporting and Evaluation Other-Data to Care Reporting Guidance for PS18-1802 and PS20-201 Modified
220109 Annual Reporting: Standards Evaluation Report (SER) Form and Instruction Modified2023 Standards Evaluation Report (SER)
220109 Annual Reporting: Standards Evaluation Report (SER) Form and Instruction Modified
205249 Laboratory Updates Form and Instruction ModifiedPediatric HIV Confidential Case Report Form
205249 Laboratory Updates Form and Instruction ModifiedAdult HIV Confidential Case Report Form
205249 Laboratory Updates Form and Instruction Modified
205248 Case Report Evaluations Form and Instruction ModifiedPediatric HIV Confidential Case Report Form
205248 Case Report Evaluations Form and Instruction ModifiedAdult HIV Confidential Case Report Form
205248 Case Report Evaluations Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2026 36 Months From Approved 02/28/2023
1,035,569 0 984,308
60,731 0 59,462
0 0 1,713,290





Reginfo record details
11
table that charts list of burden
IC Title Form No. Form Name
Adult HIV/AIDS Confidential Case Report None
Annual Reporting: Standards Evaluation Report (SER) None
Case Report Evaluations None, None ,  
Case Report Updates None, None ,  
Cluster Close-out Report None
Cluster Follow-up Report None
Data De-duplication Activities
HIV Incidence Surveillance (HIS) 0920-0573
Initial Cluster Report None
Investigation Reporting and Evaluation
Laboratory Updates None, None ,  
Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) None
Perinatal HIV Exposure Reporting (PHER) n/a

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,035,569 984,308 0 51,261 0 0
Annual Time Burden (Hours) 60,731 59,462 0 1,269 0 0
Annual Cost Burden (Dollars) 0 1,713,290 0 -1,713,290 0 0


Reginfo record details
  No