Information Collection

RCT of POC NAT or Standard of Care for HIV-positive Patients - ROI Form

IC 247952 under ICR 202512-0920-007 · OMB 0920-1357.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1357 RCT of POC NAT or Standard of Care for HIV-positive Patients - ROI Form	Form and Instruction
Form 0920-1357 Patient Authorization to Disclose, Release and/or Obtain Protected Health Information RCT of POC NAT or Standard of Care for HIV-positive Patients - ROI Form	Form and Instruction
0920-1357 Patient Authorization to Disclose, Release and/or Obtain Att 14_GAIN ROI Form.pdf	Form and Instruction
0920-1357 Patient Authorization to Disclose, Release and/or Obtain Att 14_GAIN ROI Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1357-24AQ

Is this a Common Form? No

IC Status: Removed

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	0920-1357				No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 212

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-212	212
Annual IC Time Burden (Hours)	-35	35
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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