Information Collection

Health Department Report - NHME

IC 217850 under ICR 202605-0920-005 · OMB 0920-0696.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0201 Att 3A_HIV Testing and Prevention Services Template- HD Health Department Report - NHME	Form
0920-26-0201 Att 3A_HIV Testing and Prevention Services Template- HD Att 3A_HIV Testing and Prevention Services Template for HDs and most CBOs_Revised.pdf	Form

IC Title:

Agency IC Tracking Number:

0920-26-0201

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-26-0201				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	118	-14	132
Annual IC Time Burden (Hours)	1,427	-186,871	188,298
Annual IC Cost Burden (Dollars)	0	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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