Information Collection

HIV Quality Measures Performance Measure Module (HIVQM Module)

IC 222138 under ICR 202511-0906-001 · OMB 0906-0022.

Documents and Forms

Document Name Document Type
Form 1 HIV Quality Measures Performance Measure Module (HIVQM Module) Form
Form 1 2024 HIVQM Instrument Highlighted Changes HIV Quality Measures Performance Measure Module (HIVQM Module) Form
1 2024 HIVQM Instrument Highlighted Changes 2024 HIVQM Instrument_highlighted changes (0906-0022).pdf Form
1 2024 HIVQM Instrument Highlighted Changes 2024 HIVQM Instrument_highlighted changes (0906-0022).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIV Quality Measures Performance Measure Module (HIVQM Module)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	2024 HIVQM Instrument Highlighted Changes	2024 HIVQM Instrument_highlighted changes (0906-0022).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,063	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	8,252	0	8,252
Annual IC Time Burden (Hours)	1,925	137	1,788
Annual IC Cost Burden (Dollars)	0	0	0

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.

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