Information Collection

HIV Incidence Surveillance (HIS)

IC 243727 under ICR 202208-0920-013 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0573 HIV Incidence Surveillance (HIS)	Form and Instruction
0920-0573 HIV Incidence Surveillance (HIS) Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf	Form and Instruction
0920-0573 HIV Incidence Surveillance (HIS) Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf	Form and Instruction
Att 3c_NHSS_dataelements OMB_20190313_clean.pdf Reference: Data Elements for the National HIV Surveillance System	IC Document
Att 3c_NHSS_dataelements OMB_20190313_clean.pdf Reference: Data Elements for the National HIV Surveillance System	IC Document
Att 4c_TECHNICAL GUIDANCE DUPLICATE REVIEW FINAL.pdf Technical Guidance: Duplicate Review	IC Document
Att 4c_TECHNICAL GUIDANCE DUPLICATE REVIEW FINAL.pdf Technical Guidance: Duplicate Review	IC Document

IC Title:

HIV Incidence Surveillance (HIS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0573	HIV Incidence Surveillance (HIS)	Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-15,974	15,974
Annual IC Time Burden (Hours)	-1,331	1,331
Annual IC Cost Burden (Dollars)	-143,766	143,766

Documents for IC

table that charts IC Documents
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.