Information Collection

HIV Quality Measures Performance Measure Module (HIVQM Module)

IC 222138 under ICR 202209-0906-001 · OMB 0906-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HIV Quality Measures Performance Measure Module (HIVQM Module)	Form
1 HIVQM Manual Attch B_HIVQM_Manual_2021.pdf	Form
1 HIVQM Manual Attch B_HIVQM_Manual_2021.pdf	Form

IC Title:

HIV Quality Measures Performance Measure Module (HIVQM Module)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	1	HIVQM Manual	Attch B_HIVQM_Manual_2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,063

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
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,252	-3,075	2,063	9,264
Annual IC Time Burden (Hours)	1,788	-55,584	1,788	55,584
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.