Case Report Evaluations

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 205248

Information Collection (IC) Details

View Information Collection (IC)

Case Report Evaluations
 
No Modified
 
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 None Adult HIV Confidential Case Report Form Att_3(a) Adult Case Report Form 2023 v17.pdf Yes Yes Fillable Fileable
Form and Instruction None Pediatric HIV Confidential Case Report Form Att_3(b) Pediatric Case Report Form 2023 v18.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

SORN 09-20-0136, 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 5,015 0 -59 0 0 5,074
Annual IC Time Burden (Hours) 1,672 0 -19 0 0 1,691
Annual IC Cost Burden (Dollars) 0 0 -45,666 0 0 45,666

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