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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Laboratory Updates
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
n/a
Adult HIV Case Report Form
Att 3a_Adult Case Report Form 2019_v4_OMB_rev18Jun19.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Pediatric HIV Case Report Form
Att 3b_Pediatric Case Report Form 2019_v4_OMB_rev18Jun19.pdf
Yes
Yes
Fillable Fileable
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 62812
Number of Respondents:
59
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
555,190
0
0
0
0
555,190
Annual IC Time Burden (Hours)
4,627
0
0
0
0
4,627
Annual IC Cost Burden (Dollars)
124,918
0
0
0
0
124,918
Documents for IC
Title
Document
Date Uploaded
Reference: Data Elements for the National HIV Surveillance System
Att 3c_NHSS_dataelements OMB_20190313_clean.pdf
06/26/2019
Technical Guidance: Adult HIV Case Report Form
Att 4a_ADULT HIV CONFIDENTIAL CASE REPORT FORM_20181101_TG.pdf
06/26/2019
Technical Guidance: Pediatric HIV Case Report Form
Att 4b_PEDIATRIC HIV AND PERINATAL EXPOSURE CONFIDENTIAL CASE REPORT FORM_TG..pdf
06/26/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.