Information Collection

EHE Triannual Module Documentation

IC 240018 under ICR 202212-0906-001 · OMB 0906-0051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0051 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 EHE Triannual Module Documentation	Form and Instruction
1 Ending the HIV Epidemic (EHE) Triannual Report_Documenta Ending the HIV Epidemic (EHE) Triannual Report_Documentation.pdf	Form and Instruction
1 Ending the HIV Epidemic (EHE) Triannual Report_Documenta Ending the HIV Epidemic (EHE) Triannual Report_Documentation.pdf	Form and Instruction

IC Title:

EHE Triannual Module Documentation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1	Ending the HIV Epidemic (EHE) Triannual Report_Documentation	Ending the HIV Epidemic (EHE) Triannual Report_Documentation.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 942

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	Previously Approved
Annual Number of Responses for this IC	2,826	0	2,826
Annual IC Time Burden (Hours)	5,652	565	5,087
Annual IC Cost Burden (Dollars)	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.