Brazil HIV Case Study Questionnaire

The Prevalence and Incidence of HIV Molecular Variants and Their Correlation with Risk Behaviors and HIV Treatment in Brazilian Blood Donors (NHLBI)

Documents and Forms

Document Name Document Type
Form 2 Brazil HIV Case Study Questionnaire Form and Instruction
Attach_5_Risk_Factor_Assessment_Portuguese_2_2105_V_3.0.docx Other-Portuguese Assessment Question
2 REDS-III Risk Factor Assessment Attach_1_REDS-III_Risk_Factor_Assessment_2_2015_V_3.0.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Brazil HIV Case Study Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	2	REDS-III Risk Factor Assessment	Attach_1_REDS-III_Risk_Factor_Assessment_2_2015_V_3.0.docx		Yes	Yes	Fillable Fileable
Other-Portuguese Assessment Questionnaire			Attach_5_Risk_Factor_Assessment_Portuguese_2_2105_V_3.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.