Information Collection Request

[NCHHSTP] National HIV Behavioral Surveillance System

ICR 202603-0920-004 · OMB 0920-0770 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-26-0109 Behavioral Assessment HET_Spanish Form Modified Available
Form 0920-26-0109 Behavioral Assessment HET_English Form Modified Available
Form 0920-26-0109 Behavioral Assessment PWID_Spanish Form Modified Available
Form 0920-26-0109 Behavioral Assessment PWID_English Form Modified Available
Form 0920-26-0109 Recruiter_Debriefing_Spanish Form Modified Available
Form 0920-26-0109 Recruiter_Debriefing_English Form Modified Available
Form 0920-26-0109 Behavioral Assessment MSM_Spanish Form Modified Available
Form 0920-26-0109 Behavioral Assessment MSM_English Form Modified Available
Form 0920-26-0109 Eligibility Screener Spanish Form Modified Available
Form 0920-26-0109 Eligibility Screener English Form Modified Available
Privacy Act Checklist-NHBS.docx Supplementary Document Uploaded 2026-03-10 Available
Att 10_Model Consent Form.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 9_List of Consultants_2025.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 8_NHBS Cycle Overview.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 11_CDC Project Determination.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 12_Sample analysis tables.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 13_Summary of Changes to Data Collection.docx Supplementary Document Uploaded 2026-03-10 Available
Att 14_Model Recruitment Coupon.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 15_Recruiter Training Script.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 16_Response Rate Calculations.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 17_References.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 18_Auth to Operate for DCC.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 6b_Privacy Impact Assessment.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 7_Agreement to Abide by Restrictions.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 6b_Privacy Impact Assessment.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 6a_Assurance of Confidentiality.pdf Supplementary Document Uploaded 2026-03-10 Available
Att 5_NHBS Publications.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 2b_Response to Public Comments.docx Public Comments Uploaded 2026-03-10 Available
Att 2a Public Comments.pdf Public Comments Uploaded 2026-03-10 Available
Att 2_Published 60-Day FRN.pdf Supplementary Document Uploaded 2026-03-10 Repair queued
Att 1_Authorizing Legislation.PDF Supplementary Document Uploaded 2026-03-10 Available
30 Day FRN.docx Supplementary Document Uploaded 2026-03-09 Available
Justification Memo.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-04-07 Missing upstream
Supporting Statement B.docx Supporting Statement B Uploaded 2026-03-09 Repair queued
Supporting Statement A.docx Supporting Statement A Uploaded 2026-03-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
196958 NHBS Behavioral Assessment Survey (HET) Form ModifiedBehavioral Assessment HET_Spanish
196958 NHBS Behavioral Assessment Survey (HET) Form ModifiedBehavioral Assessment HET_English
196958 NHBS Behavioral Assessment Survey (HET) Form Modified
196957 NHBS Behavioral Assessment (PWID) Form ModifiedBehavioral Assessment PWID_Spanish
196957 NHBS Behavioral Assessment (PWID) Form ModifiedBehavioral Assessment PWID_English
196957 NHBS Behavioral Assessment (PWID) Form Modified
196956 NHBS Recruiter Debriefing Form ModifiedRecruiter_Debriefing_Spanish
196956 NHBS Recruiter Debriefing Form ModifiedRecruiter_Debriefing_English
196956 NHBS Recruiter Debriefing Form Modified
182203 NHBS Behavioral Assessment (MSM) Form ModifiedBehavioral Assessment MSM_Spanish
182203 NHBS Behavioral Assessment (MSM) Form ModifiedBehavioral Assessment MSM_English
182203 NHBS Behavioral Assessment (MSM) Form Modified
182201 NHBS Screening (All Respondent Groups) Form ModifiedEligibility Screener Spanish
182201 NHBS Screening (All Respondent Groups) Form ModifiedEligibility Screener English
182201 NHBS Screening (All Respondent Groups) Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 04/30/2026
27,125 25,832
3,398 6,600
0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
NHBS Behavioral Assessment (MSM) 0920-26-0109, 0920-26-0109 ,  
NHBS Behavioral Assessment (PWID) 0920-26-0109, 0920-26-0109 ,  
NHBS Behavioral Assessment Survey (HET) 0920-26-0109, 0920-26-0109 ,  
NHBS Recruiter Debriefing 0920-26-0109, 0920-26-0109 ,  
NHBS Screening (All Respondent Groups) 0920-26-0109, 0920-26-0109 ,  

table that charts list of burden
  Total Request 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 27,125 25,832 0 1,293 0 0
Annual Time Burden (Hours) 3,398 6,600 0 -3,202 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No