Health Department Report - NHME

National HIV Prevention Program Monitoring and Evaluation (NHM&E)

Documents and Forms

Document Name Document Type
Att 5A NHME Variables.pdf Other-Data Elements

Information Collection (IC) Details

IC Title:	Health Department Report - NHME	Agency IC Tracking Number:	0920-0696

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			Att 5A NHME Variables.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 66	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	132	0	132
Annual IC Time Burden (Hours)	188,298	0	188,298
Annual IC Cost Burden (Dollars)	0	-5,114,174	5,114,174

Documents for IC

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.