[NCHHSTP] National HIV Surveillance System (NHSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Adult HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged	Repair queued
Pediatric HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Case Report Updates	Form and Instruction	Unchanged	Repair queued
Pediatric HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)	Form and Instruction	Unchanged	Repair queued
Cluster Close-out Form	Form and Instruction	Unchanged	Available
Cluster Close-out Report	Form and Instruction	Unchanged	Repair queued
Cluster Follow-up Form	Form and Instruction	Unchanged	Available
Cluster Follow-up Report	Form and Instruction	Unchanged	Repair queued
Initial Cluster Report Form	Form and Instruction	Unchanged	Available
Initial Cluster Report	Form and Instruction	Unchanged	Repair queued
Form 0920-0573-24HX Standards Evaluation Report (SER) " Surveillance Program Performance"	Form	Modified	Available
Form 0920-0573 2024 Standards Evaluation Report (SER) Surveillance Program Performance	Form and Instruction	Modified	Available
Form 0920-0573 Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction	Modified	Repair queued
Pediatric HIV Confidential Case Report Form	Form and Instruction	Unchanged	Repair queued
Adult HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Laboratory Updates	Form and Instruction	Unchanged	Repair queued
Pediatric HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Adult HIV Confidential Case Report Form	Form and Instruction	Unchanged	Available
Case Report Evaluations	Form and Instruction	Unchanged	Repair queued
Justification Memo for Nonsubstantive Change Request_0920-0573_NHSS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-05	Available
Justification Memo for Nonsubstantive Change Request_0920-0573_NHSS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-08-05	Repair queued
Att 1_ Table 1_Summary of Proposed Changes.docx	Supplementary Document	Uploaded 2023-10-17	Available
Att 1_ Table 1_Summary of Proposed Changes.docx	Supplementary Document	Uploaded 2023-10-17	Repair queued
Justification for Nonmaterial.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-10-17	Available
Justification for Nonmaterial.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-10-17	Repair queued
Att_10 Summary of Changes FINAL_08Feb22_SERv3_PWID _update_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_10 Summary of Changes FINAL_08Feb22_SERv3_PWID _update_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_9_Project Determination.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_9_Project Determination.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_8_Data Security and Confidentiality Guidelines.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_8_Data Security and Confidentiality Guidelines.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_7(b) NHSS_ Complete AoC_Final updated 102621 per amendment_CSpacket.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_7(b) NHSS_ Complete AoC_Final updated 102621 per amendment_CSpacket.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_7(a) NHSS_ AoC Statement_FinalOct2019.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_7(a) NHSS_ AoC Statement_FinalOct2019.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_6(b) ATO.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_6(b) ATO.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_6(a) PIA.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_6(a) PIA.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_5 cdc-hiv-surveillance-report-2020-updated-vol-33.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_5 cdc-hiv-surveillance-report-2020-updated-vol-33.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(e) DETECTING HIV TRANSMISSION CLUSTERS 2022 v1 (1).pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(e) DETECTING HIV TRANSMISSION CLUSTERS 2022 v1 (1).pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(d) D2C-Monitoring-and-Evaluation-Guidance _Jun21fin_508C_8.30.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(d) D2C-Monitoring-and-Evaluation-Guidance _Jun21fin_508C_8.30.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(c) DUPLICATE REVIEW 2022 v1.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(c) DUPLICATE REVIEW 2022 v1.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(b) PEDIATRIC HIV CASE REPORT FORM 2023 v2_PWID edit_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(b) PEDIATRIC HIV CASE REPORT FORM 2023 v2_PWID edit_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_4(a) ADULT HIV CONFIDENTIAL CASE REPORT FORM 2023 v2.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_4(a) ADULT HIV CONFIDENTIAL CASE REPORT FORM 2023 v2.pdf	Supplementary Document	Uploaded 2022-09-08	Repair queued
Att_3(c) NHSS_dataelements_OMB_BG_KB_Clean_PWID edit_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_3(c) NHSS_dataelements_OMB_BG_KB_Clean_PWID edit_clean.pdf	Supplementary Document	Uploaded 2022-09-08	Available
Att_2(a) 60 Day FRN pub 4 -1-2022.pdf	Supplementary Document	Uploaded 2022-09-07	Available
Att_2(a) 60 Day FRN pub 4 -1-2022.pdf	Supplementary Document	Uploaded 2022-09-07	Repair queued
Att_1_ Authorizing Legislation.pdf	Supplementary Document	Uploaded 2022-09-07	Available
Att_1_ Authorizing Legislation.pdf	Supplementary Document	Uploaded 2022-09-07	Repair queued
SSB_08Aug22_clean.docx	Supporting Statement B	Uploaded 2022-09-07	Available
SSB_08Aug22_clean.docx	Supporting Statement B	Uploaded 2022-09-07	Repair queued
SSA_NHSS_31AUG22_clean.docx	Supporting Statement A	Uploaded 2022-09-07	Available
SSA_NHSS_31AUG22_clean.docx	Supporting Statement A	Uploaded 2022-09-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7028	Adult HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged	Adult HIV Confidential Case Report Form
7028	Adult HIV/AIDS Confidential Case Report	Form and Instruction	Unchanged
46032	Case Report Updates	Form and Instruction	Unchanged	Pediatric HIV Confidential Case Report Form
46032	Case Report Updates	Form and Instruction	Unchanged	Adult HIV Confidential Case Report Form
46032	Case Report Updates	Form and Instruction	Unchanged
46030	Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)	Form and Instruction	Unchanged	Pediatric HIV Confidential Case Report Form
46030	Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)	Form and Instruction	Unchanged
236513	Data De-duplication Activities	Other-Technical Guidance for HIV Surveillance Programs: Duplicat	Unchanged
236512	Cluster Close-out Report	Form and Instruction	Unchanged	Cluster Close-out Form
236512	Cluster Close-out Report	Form and Instruction	Unchanged
236511	Cluster Follow-up Report	Form and Instruction	Unchanged	Cluster Follow-up Form
236511	Cluster Follow-up Report	Form and Instruction	Unchanged
236510	Initial Cluster Report	Form and Instruction	Unchanged	Initial Cluster Report Form
236510	Initial Cluster Report	Form and Instruction	Unchanged
236509	Investigation Reporting and Evaluation	Other-Data to Care Reporting Guidance for PS18-1802 and PS20-201	Unchanged
220109	Annual Reporting: Standards Evaluation Report (SER)	Form	Modified	Standards Evaluation Report (SER) " Surveillance Program Performance"
220109	Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction	Modified	2024 Standards Evaluation Report (SER) Surveillance Program Performance
220109	Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction	Modified
205249	Laboratory Updates	Form and Instruction	Unchanged	Pediatric HIV Confidential Case Report Form
205249	Laboratory Updates	Form and Instruction	Unchanged	Adult HIV Confidential Case Report Form
205249	Laboratory Updates	Form and Instruction	Unchanged
205248	Case Report Evaluations	Form and Instruction	Unchanged	Pediatric HIV Confidential Case Report Form
205248	Case Report Evaluations	Form and Instruction	Unchanged	Adult HIV Confidential Case Report Form
205248	Case Report Evaluations	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0573	ICR Reference No: 202408-0920-003
Status: Historical Active	Previous ICR Reference No: 202310-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0573-24HX
Title: [NCHHSTP] National HIV Surveillance System (NHSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/22/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/06/2024
Terms of Clearance: Previous Terms of Clearance continue: CDC may submit non-substantive change requests when changes to this ICR that are limited to modifying existing questions, including those designed to add depth/additional detail, and to cycle in and out questions that have been cleared under this OMB number in the past years (with modest updates to wording and scope

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2026	02/28/2026	02/28/2026
Responses	1,035,569	0	1,035,569
Time Burden (Hours)	60,731	0	60,731
Cost Burden (Dollars)	0	0	0

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Abstract: Requesting a non-substantial change to the information collection request (ICR) for the National HIV Surveillance System (NHSS) OMB #0920-0573. Specifically, requesting modifications to the Standards Evaluation Report (SER) (attachment 3d) to align with information needed to assess HIV surveillance program performance in the new NOFO PS24-0047 High-Impact HIV Prevention and Surveillance Programs for Health Departments. These changes in the SER will be implemented in the next report requested in February 2025 based on work conducted through the end of 2024. The edits consist of formatting and wording changes to better capture performance measures, questions to capture newly added process and outcome standards, deletion of questions no longer needed, and opportunities to provide contextual information. These contextual questions were previously answered separately in an end of year report (EOYR) and are being moved to the SER so all information on performance is captured together. These questions will only be answered by health departments that have not met performance standards.

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Authorizing Statute(s): US Code: 42 USC 247c Name of Law: Sexually Transmitted Diseases; Prevention and Control Projects and Programs
   US Code: 42 USC 247b Name of Law: Project Grants for Preventive Health Services
   US Code: 42 USC 242b Name of Law: General Authority Respecting Research...
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 19097	04/01/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 55812	09/12/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Adult HIV/AIDS Confidential Case Report	None	Adult HIV Confidential Case Report Form
Annual Reporting: Standards Evaluation Report (SER)	0920-0573, 0920-0573-24HX	2024 Standards Evaluation Report (SER) Surveillance Program Performance ,   Standards Evaluation Report (SER) " Surveillance Program Performance"
Case Report Evaluations	None, None	Adult HIV Confidential Case Report Form ,   Pediatric HIV Confidential Case Report Form
Case Report Updates	None, None	Adult HIV Confidential Case Report Form ,   Pediatric HIV Confidential Case Report Form
Cluster Close-out Report	None	Cluster Close-out Form
Cluster Follow-up Report	None	Cluster Follow-up Form
Data De-duplication Activities
Initial Cluster Report	None	Initial Cluster Report Form
Investigation Reporting and Evaluation
Laboratory Updates	None, None	Adult HIV Confidential Case Report Form ,   Pediatric HIV Confidential Case Report Form
Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information)	None	Pediatric HIV Confidential Case Report Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,035,569	1,035,569	0	0	0	0
Annual Time Burden (Hours)	60,731	60,731	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $66,043,503

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/06/2024

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