Information Collection

HIV sample collection

IC 262653 under ICR 202504-0920-010 · OMB 0920-1421.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HIV sample collection	Form and Instruction
HIV Sample Collection HIV sample collection	Form and Instruction
HIV Sample Collection (Spanish) HIV sample collection	Form and Instruction
HIV Sample Collection Att 4e_HIV sample collection English.docx	Form and Instruction
HIV Sample Collection Att 4e_HIV sample collection English.docx	Form and Instruction
HIV Sample Collection (Spanish) Att 4e_HIV sample collection Spanish.docx	Form and Instruction
HIV Sample Collection (Spanish) Att 4e_HIV sample collection Spanish.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-25-0073

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a				No		Paper Only
Form and Instruction	n/a				No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	567	567
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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