[NCHHSTP] National HIV Prevention Program Monitoring and Evaluation (NHM&E)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-26-0201 Att 3B_HIV Testing and Prevention Services Template- CBO	Form	New	Available
Form 0920-26-0201 Att 3A_HIV Testing and Prevention Services Template- CBO	Form	Modified	Available
Form 0920-26-0201 Att 3A_HIV Testing and Prevention Services Template- HD	Form	Modified	Available
Att 3C_Revisions to NHM&E Data Requirements for HDs and most CBOs_Revised.pdf	Supplementary Document	Uploaded 2026-06-03	Available
Att 7B_Authority to Operate for 1-CDP.pdf	Supplementary Document	Uploaded 2026-06-02	Available
Att 7A_ATO EvaluationWeb email expiration in 2027.pdf	Supplementary Document	Uploaded 2026-06-02	Available
Att 6_Auth to Extend 308 d AofC Protection.pdf	Supplementary Document	Uploaded 2026-06-02	Available
Att 4B_REDCap screenshots.docx	Supplementary Document	Uploaded 2026-06-02	Available
Att 2B_Public Comment Response.pdf	Public Comments	Uploaded 2026-06-02	Available
Att 4A_EvaluationWeb screen shots.docx	Supplementary Document	Uploaded 2026-06-02	Available
Att 2B_Public Comment Response.pdf	Public Comments	Uploaded 2026-05-27	Available
Privacy Act Checklist.docx	Supplementary Document	Uploaded 2026-05-27	Available
Att 3C_Revisions-Data Requirements.pdf	Supplementary Document	Uploaded 2026-05-27	Available
Att 1_Legislative Auth.pdf	Supplementary Document	Uploaded 2026-05-27	Available
Att 4 Agencies and Persons Consulted 2024.docx	Supplementary Document	Uploaded 2024-10-23	Available
Att 6 Data Security Guidelines.pdf	Supplementary Document	Uploaded 2024-10-23	Available
Att 8 NHM&E Updated AoC Conditional approval 2027.docx	Supplementary Document	Uploaded 2024-10-23	Available
Att 6 Data Security Guidelines.pdf	Supplementary Document	Uploaded 2024-10-23	Available
Att 2 60-day FRN.pdf	Supplementary Document	Uploaded 2024-10-23	Available
FRN_Publication_Request_Worksheet.pdf	Supplementary Document	Uploaded 2024-10-23	Available
Project Determination_NHME.docx	Supplementary Document	Uploaded 2024-10-23	Available
Att 1 Legislative Authority.pdf	Supplementary Document	Uploaded 2024-10-23	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2026-06-02	Available
Supporting Statement A.docx	Supporting Statement A	Uploaded 2026-06-02	Available
Att 3 NHME_EvaluationWeb screen shots.docx	Supplementary Document	Uploaded 2021-05-13	Available
Att 11 Explanation of Revisions.docx	Supplementary Document	Uploaded 2021-05-13	Available
Att 10 2016 EvalWeb PIA signed.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 9 2017 Final AoC docs NHM&E.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 8 Burden Calculations.docx	Supplementary Document	Uploaded 2021-05-13	Available
Att 7 EvalWeb signed ATO.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 6 Data Security Guidelines.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 5B NHME Variables To Be Removed.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 4 Agencies and Persons Consulted 2021.docx	Supplementary Document	Uploaded 2021-05-13	Available
Att 2 60-Day FRN Pub 11-02-2020.pdf	Supplementary Document	Uploaded 2021-05-13	Available
Att 1 Legislative Authority.pdf	Supplementary Document	Uploaded 2018-08-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
280689	HIV testing and prevention services template-CBO	Form	New	Att 3B_HIV Testing and Prevention Services Template- CBO
217851	HIV testing & prevention services template -Community-Based Organization	Form	Modified	Att 3A_HIV Testing and Prevention Services Template- CBO
217850	Health Department Report - NHME	Form	Modified	Att 3A_HIV Testing and Prevention Services Template- HD

ICR Details

OMB Control No: 0920-0696	ICR Reference No: 202605-0920-005
Status: Received in OIRA	Previous ICR Reference No: 202410-0920-022
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0201
Title: [NCHHSTP] National HIV Prevention Program Monitoring and Evaluation (NHM&E)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/03/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2028
Responses	418	432
Time Burden (Hours)	2,467	204,498
Cost Burden (Dollars)	0	0

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Abstract: NHM&E data are a set of standardized variables that CDC uses to monitor and evaluate HIV prevention programs funded by the Division of HIV/AIDS Prevention (DHAP) at CDC. These data are used to report key program performance indicators to CDC to show whether the programs implemented or supported are efficient and effective in achieving their stated goals. NHM&E data also assist Health Departments and Community-Based Organizations (CBOs) in monitoring and evaluating their activities to help them develop, deliver, and refine successful HIV prevention interventions. A revision is requested to extend data collection for 3 years and to add/remove variables from existing data collection instruments. The revision of the currently approved ICR is intended to accommodate the new reporting requirements for CDC’s newest prevention program cooperative agreement (CDC-RFA-PS24-0047). The revisions include the following: (1) additions and updates to Race and Ethnicity data collection, in alignment with OMB’s SPD–15 directives; (2) deletion and modification of variables in alignment with Executive Orders; (3) deletion and modification of PrEP-related variables in alignment with screening and eligibility recommendation changes; (4) inclusion of antiretroviral therapy, PEP, Mpox, tuberculosis, Hepatitis B, and modification of response options for Hepatitis C, Chlamydia, Gonorrhea, and Syphilis testing, treatment, and referral variables; (5) modification of variables and response options for Essential Support Services screening, determination, referral, and provision variables; and (6) addition of new jurisdiction-level aggregate and qualitative variables.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 52672	11/21/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 32974	06/02/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
HIV testing & prevention services template -Community-Based Organization	0920-26-0201	Att 3A_HIV Testing and Prevention Services Template- CBO
HIV testing and prevention services template-CBO	0920-26-0201	Att 3B_HIV Testing and Prevention Services Template- CBO
Health Department Report - NHME	0920-26-0201	Att 3A_HIV Testing and Prevention Services Template- HD

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ICR Summary of Burden

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	418	432	0	-314	300	0
Annual Time Burden (Hours)	2,467	204,498	0	-218,231	16,200	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This revision is requesting three years of approval for 2467 hours annually.

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Annual Cost to Federal Government: $2,075,632

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/03/2026

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