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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Perinatal HIV Exposure Reporting (PHER)
Agency IC Tracking Number:
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 and Instruction
NA
Perinatal HIV Exposure Reporting (PHER) Form
Att 3d_Suppl Surv Activity 3 PHER.pdf
NA
Yes
Yes
Fillable Fileable
Instruction
Att_3c_NHSS_dataelements OMB 21Dec2015.pdf
NA
Yes
Yes
Fillable Fileable
Instruction
Att 4b_Technical Guidance PCRF_PHER_20151030_v4_OMB.pdf
NA
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC
FR Citation:
57 FR 61812
Number of Respondents:
35
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
3,990
0
0
0
0
3,990
Annual IC Time Burden (Hours)
1,995
0
0
0
0
1,995
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Final Att 3f_CRF Changes
Final Att 3f_CRF Changes.docx
12/19/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.