[NCHHSTP] National HIV Behavioral Surveillance System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-25-0074 Behavioral_Assessment_HET_English	Form	Modified	Available
Form 0920-25-0074 Behavioral_Assessment_HET_Spanish	Form	Modified	Available
Form 0920-0770 Behavioral Assessment for HET (Spanish)	Form and Instruction	Modified	Available
Form 0920-0770 Behavioral Assessment for HET (English)	Form and Instruction	Modified	Available
Form 0920-0770 NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Repair queued
Form 0920-25-0074 Behavioral_Assessment_PWID_SPA	Form	Modified	Available
Form 0920-25-0074 Behavioral_Assessment_PWID_English	Form	Modified	Available
Form 0920-0770 Behavioral Assessment for PWID (Spanish)	Form and Instruction	Modified	Available
Form 0920-0770 Behavioral Assessment for PWID (English)	Form and Instruction	Modified	Available
Form 0920-0770 NHBS Behavioral Assessment (PWID)	Form and Instruction	Modified	Repair queued
Form 0920-0770 Recruiter Debriefing (Spanish)	Form and Instruction	Unchanged	Available
Form 0920-0770 Recruiter Debriefing (English)	Form and Instruction	Unchanged	Available
Form 0920-0770 NHBS Recruiter Debriefing	Form and Instruction	Unchanged	Repair queued
Form 0920-25-0074 Behavioral_Assessment_Spanish	Form	Modified	Available
Form 0920-25-0074 Behavioral_Assessment_English	Form	Modified	Available
Form 0920-0770 Behavioral Assessment for MSM (Spanish)	Form and Instruction	Modified	Available
Form 0920-0770 Behavioral Assessment for MSM (English)	Form and Instruction	Modified	Available
Form 0920-0770 NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Repair queued
Form 0920-25-0074 Eligibility Screener Spanish	Form	Modified	Available
Form 0920-25-0074 Eligibility Screener English	Form	Modified	Available
Form 0920-0770 Eligibility Screener (Spanish)	Form and Instruction	Modified	Available
Form 0920-0770 Eligibility Screener (English)	Form and Instruction	Modified	Available
Form 0920-0770 NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Repair queued
Justification Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-04-07	Available
Justification Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-04-07	Repair queued
Att 15_Recruiter Training Script.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 15_Recruiter Training Script.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 18_DCC ATO.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 18_DCC ATO.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 17_References.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 17_References.pdf	Supplementary Document	Uploaded 2022-08-10	Missing upstream
Att 16_Response Rate Calculations.docx	Supplementary Document	Uploaded 2022-08-10	Available
Att 16_Response Rate Calculations.docx	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 14_Model Recruitment Coupon.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 14_Model Recruitment Coupon.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 13_Summary of Changes to Data Collection_OIRA 4.5.23 cw_final.docx	Supplementary Document	Uploaded 2023-04-11	Available
Att 13_Summary of Changes to Data Collection_OIRA 4.5.23 cw_final.docx	Supplementary Document	Uploaded 2023-04-11	Repair queued
Att 12_Sample analysis tables.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 12_Sample analysis tables.pdf	Supplementary Document	Uploaded 2022-08-10	Missing upstream
Att 11_Project Determination.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 11_Project Determination.pdf	Supplementary Document	Uploaded 2022-08-10	Missing upstream
Att 10_Model Consent Form.pdf	Supplementary Document	Uploaded 2022-12-14	Available
Att 10_Model Consent Form.pdf	Supplementary Document	Uploaded 2022-12-14	Missing upstream
Att 9_List of Consultants.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 9_List of Consultants.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 8_NHBS Cycle Overview.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 8_NHBS Cycle Overview.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 7_Agreement to Abide by Restrictions.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 7_Agreement to Abide by Restrictions.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 6b_Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 6b_Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 6a_Assurance of Confidentiality.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 6a_Assurance of Confidentiality.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 5_NHBS Publications.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 5_NHBS Publications.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 2 NHBS 60 Day FRN.pdf	Supplementary Document	Uploaded 2022-08-10	Available
Att 2 NHBS 60 Day FRN.pdf	Supplementary Document	Uploaded 2022-08-10	Repair queued
Att 1_Sect 301 PHSA.PDF	Supplementary Document	Uploaded 2022-08-10	Available
Att 1_Sect 301 PHSA.PDF	Supplementary Document	Uploaded 2022-08-10	Repair queued
Supporting Statement B_clean.docx	Supporting Statement B	Uploaded 2025-04-07	Available
Supporting Statement B_clean.docx	Supporting Statement B	Uploaded 2025-04-07	Repair queued
Supporting Statement A_clean.docx	Supporting Statement A	Uploaded 2025-04-07	Available
Supporting Statement A_clean.docx	Supporting Statement A	Uploaded 2025-04-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196958	NHBS Behavioral Assessment Survey (HET)	Form	Modified	Behavioral_Assessment_HET_English
196958	NHBS Behavioral Assessment Survey (HET)	Form	Modified	Behavioral_Assessment_HET_Spanish
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Behavioral Assessment for HET (Spanish)
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified	Behavioral Assessment for HET (English)
196958	NHBS Behavioral Assessment Survey (HET)	Form and Instruction	Modified
196957	NHBS Behavioral Assessment (PWID)	Form	Modified	Behavioral_Assessment_PWID_SPA
196957	NHBS Behavioral Assessment (PWID)	Form	Modified	Behavioral_Assessment_PWID_English
196957	NHBS Behavioral Assessment (PWID)	Form and Instruction	Modified	Behavioral Assessment for PWID (Spanish)
196957	NHBS Behavioral Assessment (PWID)	Form and Instruction	Modified	Behavioral Assessment for PWID (English)
196957	NHBS Behavioral Assessment (PWID)	Form and Instruction	Modified
196956	NHBS Recruiter Debriefing	Form and Instruction	Unchanged	Recruiter Debriefing (Spanish)
196956	NHBS Recruiter Debriefing	Form and Instruction	Unchanged	Recruiter Debriefing (English)
196956	NHBS Recruiter Debriefing	Form and Instruction	Unchanged
182203	NHBS Behavioral Assessment (MSM)	Form	Modified	Behavioral_Assessment_Spanish
182203	NHBS Behavioral Assessment (MSM)	Form	Modified	Behavioral_Assessment_English
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Behavioral Assessment for MSM (Spanish)
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified	Behavioral Assessment for MSM (English)
182203	NHBS Behavioral Assessment (MSM)	Form and Instruction	Modified
182201	NHBS Screening (All Respondent Groups)	Form	Modified	Eligibility Screener Spanish
182201	NHBS Screening (All Respondent Groups)	Form	Modified	Eligibility Screener English
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Eligibility Screener (Spanish)
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified	Eligibility Screener (English)
182201	NHBS Screening (All Respondent Groups)	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0770	ICR Reference No: 202504-0920-007
Status: Historical Active	Previous ICR Reference No: 202208-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0770-25-0074
Title: [NCHHSTP] National HIV Behavioral Surveillance System
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: 05/09/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/05/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	04/30/2026	04/30/2026
Responses	25,832	0	25,832
Time Burden (Hours)	6,600	0	6,600
Cost Burden (Dollars)	0	0	0

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Abstract: The National HIV Behavioral Surveillance system (NHBS) is a supplemental surveillance project designed to describe the HIV prevalence and behaviors related to HIV acquisition and prevention among the three populations at highest risk for HIV in the United States: men who have sex with men, persons who inject drugs, and heterosexually active persons at increased risk for HIV infection. For this Revision, interview data collection instruments were revised and the number of health departments participating in the NHBS System will decrease, in addition to other minor changes.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
   US Code: 42 USC 301 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 29323	05/13/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 49849	08/12/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
NHBS Behavioral Assessment (MSM)	0920-0770, 0920-0770, 0920-25-0074, 0920-25-0074	Behavioral Assessment for MSM (English) ,   Behavioral Assessment for MSM (Spanish) ,   Behavioral_Assessment_English ,   Behavioral_Assessment_Spanish
NHBS Behavioral Assessment (PWID)	0920-0770, 0920-0770, 0920-25-0074, 0920-25-0074	Behavioral Assessment for PWID (English) ,   Behavioral Assessment for PWID (Spanish) ,   Behavioral_Assessment_PWID_English ,   Behavioral_Assessment_PWID_SPA
NHBS Behavioral Assessment Survey (HET)	0920-0770, 0920-0770, 0920-25-0074, 0920-25-0074	Behavioral Assessment for HET (English) ,   Behavioral Assessment for HET (Spanish) ,   Behavioral_Assessment_HET_Spanish ,   Behavioral_Assessment_HET_English
NHBS Recruiter Debriefing	0920-0770, 0920-0770	Recruiter Debriefing (English) ,   Recruiter Debriefing (Spanish)
NHBS Screening (All Respondent Groups)	0920-0770, 0920-0770, 0920-25-0074, 0920-25-0074	Eligibility Screener (English) ,   Eligibility Screener (Spanish) ,   Eligibility Screener English ,   Eligibility Screener Spanish

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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	25,832	25,832	0	0	0	0
Annual Time Burden (Hours)	6,600	6,600	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: $13,205,639

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: 05/05/2025

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