View Information Collection (IC)

View Information Collection (IC)

IC Title:	QDRL - questions for National HIV Behavioral Surveillance system and on gender	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NHBS questions for cognitive testing	QDRL 10-day letter NHBS Att 1 -Instruments-v2.docx		No	Yes	Fillable Fileable
Form	none	NHBS screeners	QDRL 10-day letter NHBS Att 3abcd-screeners-v2.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population	FR Citation: 49 FR 37693

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	75	0	0	0	0	0
Annual IC Time Burden (Hours)	113	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment flyers	QDRL 10-day letter NHBS Att 2abc -flyers & adv.docx	11/22/2010
Letter to OMB - Justification	QDRL OMB-10-day letter-NHBS-112210.doc	11/22/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.