[NCHHSTP] National HIV Behavioral Surveillance: Brief HIV Bio-behavioral Assessment (NHBS-BHBA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1398 Model Qualitative Data Collection Instrument_Spanish_REVISED 27MAR2025	Form and Instruction	Modified	Available
Form 0920-1398 Model Qualitative Data Collection Instrument_English_REVISED 27MAR2025	Form and Instruction	Modified	Available
Qualitative Interviews (Spanish)	Form and Instruction	Modified	Available
Qualitative Interviews (English)	Form and Instruction	Modified	Available
Qualitative Interviews	Form and Instruction	Modified	Repair queued
Qualitative Eligibility Screener (Spanish)	Form and Instruction	Unchanged	Available
Qualitative Eligibility Screener (English)	Form and Instruction	Unchanged	Available
Qualitative Eligibility Screener	Form and Instruction	Unchanged	Available
Quantitative Population-specific Questions (Spanish)	Form and Instruction	Unchanged	Available
Quantitative Population-specific Questions (English)	Form and Instruction	Unchanged	Available
Quantitative Population-specific Questions	Form and Instruction	Unchanged	Available
Quantitative Core Survey (Spanish)	Form and Instruction	Unchanged	Available
Quantitative Core Survey (English)	Form and Instruction	Unchanged	Available
Quantitative Core Survey	Form and Instruction	Unchanged	Available
Form 0920-1398 Quantitative Population Eligibility Screener_Spanish_REVISED 27MAR2025	Form and Instruction	Modified	Available
Form 0920-1398 Quantitative Population Eligibility Screener_English_REVISED 27MAR2025	Form and Instruction	Modified	Available
Quantitative Population Eligibility Screener (Spanish)	Form and Instruction	Modified	Available
Quantitative Population Eligibility Screener (English)	Form and Instruction	Modified	Available
Quantitative Population Eligibility Screener	Form and Instruction	Modified	Repair queued
Quantitative Base Eligibility Screener (Spanish)	Form and Instruction	Unchanged	Available
Quantitative Base Eligibility Screener (English)	Form and Instruction	Unchanged	Available
Quantitative Base Eligibility Screener	Form and Instruction	Unchanged	Missing upstream
Justification Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-27	Available
Justification Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-27	Available
Att 11_Summary of NHBS-BHBA Data Collection_clean.docx	Supplementary Document	Uploaded 2025-03-27	Available
Att 11_Summary of NHBS-BHBA Data Collection_clean.docx	Supplementary Document	Uploaded 2025-03-27	Missing upstream
Att 11_Summary of NHBS-BHBA Data Collection_20230524_clean.docx	Supplementary Document	Uploaded 2023-06-01	Available
Att 11_Summary of NHBS-BHBA Data Collection_20230524_clean.docx	Supplementary Document	Uploaded 2023-06-01	Available
0920-1398_NHBS-BHBA_Change Request_20230524.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-01	Available
0920-1398_NHBS-BHBA_Change Request_20230524.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-01	Repair queued
SSA HIV Behavioral Surveillance BHBA_09302022.docx	Supporting Statement A	Uploaded 2022-09-30	Repair queued
SSA HIV Behavioral Surveillance BHBA_09302022.docx	Supporting Statement A	Uploaded 2022-09-30	Missing upstream
Att 11_Summary of NHBS-BHBA Data Collection_clean.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 11_Summary of NHBS-BHBA Data Collection_clean.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 10_Analysis Tables.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 10_Analysis Tables.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 9_Project Determination.pdf	Supplementary Document	Uploaded 2022-09-29	Available
Att 9_Project Determination.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8d_Model Qualitative FG Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 8d_Model Qualitative FG Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8c_Model Qualitative CKI Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8c_Model Qualitative CKI Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8b_Model Qualitative PKI Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8b_Model Qualitative PKI Consent Form.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 8a_Model Survey Consent Form.pdf	Supplementary Document	Uploaded 2022-11-09	Repair queued
Att 8a_Model Survey Consent Form.pdf	Supplementary Document	Uploaded 2022-11-09	Repair queued
Att 7_BHBA cycle overview.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 7_BHBA cycle overview.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 6_Agreement to Abide by Restrictions_rev.docx	Supplementary Document	Uploaded 2022-09-29	Available
Att 6_Agreement to Abide by Restrictions_rev.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 5b_BHBA_PIA Form.pdf	Supplementary Document	Uploaded 2022-09-29	Available
Att 5b_BHBA_PIA Form.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 5a_Assurance of Confidentiality.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 5a_Assurance of Confidentiality.docx	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 2b_Memo in response to public comment on NHBS 60-day FRN 20220513.pdf	Supplementary Document	Uploaded 2022-09-29	Available
Att 2b_Memo in response to public comment on NHBS 60-day FRN 20220513.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 2a_Public comments.pdf	Supplementary Document	Uploaded 2022-09-29	Available
Att 2a_Public comments.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 2_60 Day FRN.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
Att 2_60 Day FRN.pdf	Supplementary Document	Uploaded 2022-09-29	Missing upstream
Att 1_PHSA.pdf	Supplementary Document	Uploaded 2022-09-29	Available
Att 1_PHSA.pdf	Supplementary Document	Uploaded 2022-09-29	Repair queued
BHBA_Supporting Statement B.docx	Supporting Statement B	Uploaded 2022-09-29	Available
BHBA_Supporting Statement B.docx	Supporting Statement B	Uploaded 2022-09-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
255848	Qualitative Interviews	Form and Instruction	Modified	Model Qualitative Data Collection Instrument_Spanish_REVISED 27MAR2025
255848	Qualitative Interviews	Form and Instruction	Modified	Model Qualitative Data Collection Instrument_English_REVISED 27MAR2025
255848	Qualitative Interviews	Form and Instruction	Modified	Qualitative Interviews (Spanish)
255848	Qualitative Interviews	Form and Instruction	Modified	Qualitative Interviews (English)
255848	Qualitative Interviews	Form and Instruction	Modified
255847	Qualitative Eligibility Screener	Form and Instruction	Unchanged	Qualitative Eligibility Screener (Spanish)
255847	Qualitative Eligibility Screener	Form and Instruction	Unchanged	Qualitative Eligibility Screener (English)
255847	Qualitative Eligibility Screener	Form and Instruction	Unchanged
255846	Quantitative Population-specific Questions	Form and Instruction	Unchanged	Quantitative Population-specific Questions (Spanish)
255846	Quantitative Population-specific Questions	Form and Instruction	Unchanged	Quantitative Population-specific Questions (English)
255846	Quantitative Population-specific Questions	Form and Instruction	Unchanged
255845	Quantitative Core Survey	Form and Instruction	Unchanged	Quantitative Core Survey (Spanish)
255845	Quantitative Core Survey	Form and Instruction	Unchanged	Quantitative Core Survey (English)
255845	Quantitative Core Survey	Form and Instruction	Unchanged
255844	Quantitative Population Eligibility Screener	Form and Instruction	Modified	Quantitative Population Eligibility Screener_Spanish_REVISED 27MAR2025
255844	Quantitative Population Eligibility Screener	Form and Instruction	Modified	Quantitative Population Eligibility Screener_English_REVISED 27MAR2025
255844	Quantitative Population Eligibility Screener	Form and Instruction	Modified	Quantitative Population Eligibility Screener (Spanish)
255844	Quantitative Population Eligibility Screener	Form and Instruction	Modified	Quantitative Population Eligibility Screener (English)
255844	Quantitative Population Eligibility Screener	Form and Instruction	Modified
255843	Quantitative Base Eligibility Screener	Form and Instruction	Unchanged	Quantitative Base Eligibility Screener (Spanish)
255843	Quantitative Base Eligibility Screener	Form and Instruction	Unchanged	Quantitative Base Eligibility Screener (English)
255843	Quantitative Base Eligibility Screener	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1398	ICR Reference No: 202503-0920-034
Status: Historical Inactive	Previous ICR Reference No: 202305-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1398-25-0075
Title: [NCHHSTP] National HIV Behavioral Surveillance: Brief HIV Bio-behavioral Assessment (NHBS-BHBA)
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: Disapproved and continue	Conclusion Date: 06/06/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance: Please review and revise for compliance with EO 14168 and administration policy. Including the SSA.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	05/31/2026	06/30/2025
Responses	4,718	0	4,718
Time Burden (Hours)	494	0	494
Cost Burden (Dollars)	0	0	0

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Abstract: The primary objective of NHBS-BHBA is to conduct mixed-methods behavioral surveillance among populations at high risk for HIV in selected geographic areas of interest to assess: 1) risk behaviors and social determinants of health for HIV infection, 2) HIV testing behaviors and treatment, 3) HIV seroprevalence and incidence, and 4) exposure to, use of, and impact of HIV prevention services. Through this project, funded state health departments for NHBS-BHBA will work with local entities to collect surveillance data to understand HIV risk, especially in areas or populations with limited information. Non-Substantive Change Request submitted to modify package documents for compliance with recently issued EOs. There is no change anticipated to the burden hours.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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 29316	05/13/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 59430	09/30/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Qualitative Eligibility Screener	None, None	Qualitative Eligibility Screener (English) ,   Qualitative Eligibility Screener (Spanish)
Qualitative Interviews	None, None, 0920-1398, 0920-1398	Qualitative Interviews (English) ,   Qualitative Interviews (Spanish) ,   Model Qualitative Data Collection Instrument_English_REVISED 27MAR2025 ,   Model Qualitative Data Collection Instrument_Spanish_REVISED 27MAR2025
Quantitative Base Eligibility Screener	None, None	Quantitative Base Eligibility Screener (English) ,   Quantitative Base Eligibility Screener (Spanish)
Quantitative Core Survey	None, None	Quantitative Core Survey (English) ,   Quantitative Core Survey (Spanish)
Quantitative Population Eligibility Screener	None, None, 0920-1398, 0920-1398	Quantitative Population Eligibility Screener (English) ,   Quantitative Population Eligibility Screener (Spanish) ,   Quantitative Population Eligibility Screener_English_REVISED 27MAR2025 ,   Quantitative Population Eligibility Screener_Spanish_REVISED 27MAR2025
Quantitative Population-specific Questions	None, None	Quantitative Population-specific Questions (English) ,   Quantitative Population-specific Questions (Spanish)

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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: $1,239,795

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: 03/28/2025

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