Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)

National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 46030

Information Collection (IC) Details

View Information Collection (IC)

Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)
 
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 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 3,363 0 3,186 0 0 177
Annual IC Time Burden (Hours) 1,962 0 1,903 0 0 59
Annual IC Cost Burden (Dollars) 0 0 -1,593 0 0 1,593

Title Document Date Uploaded
Technical Guidance: Pediatric HIV Confidential Case Report Form Att_4(b) PEDIATRIC HIV CASE REPORT FORM 2023 v2_PWID edit_clean.pdf 09/07/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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