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Initial Cluster Report
[NCHHSTP] National HIV Surveillance System (NHSS)
OMB: 0920-0573
IC ID: 236510
OMB.report
HHS/CDC
OMB 0920-0573
ICR 202602-0920-009
IC 236510
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Initial Cluster Report
Agency IC Tracking Number:
0920-0573
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-0573
Initial Cluster Report Form
Att_3e Inital Cluster Report Form.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
SORN 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC
FR Citation:
57 FR 62812
Number of Respondents:
59
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
148
0
0
0
0
148
Annual IC Time Burden (Hours)
148
0
0
0
0
148
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Cluster Report Form Instructions
Att_4f Cluster Report Form Instructions Nov 2025.pdf
02/23/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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