Adult HIV/AIDS Confidential Case Report

[NCHHSTP] National HIV Surveillance System (NHSS)

OMB: 0920-0573

IC ID: 7028

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Document Name
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Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
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IC Document
Information Collection (IC) Details

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Adult HIV/AIDS Confidential Case Report
 
No Unchanged
 
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 Adult HIV Confidential Case Report Form Att_3(a) Adult Case Report Form 2023 v17.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 46,551 0 0 0 0 46,551
Annual IC Time Burden (Hours) 15,517 0 0 0 0 15,517
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Technical Guidance: Adult HIV Confidential Case Report Form (2023) Att_4(a) ADULT HIV CONFIDENTIAL CASE REPORT FORM 2023 v2.pdf 09/07/2022
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