Forms and Documents

Document Name	Status
Adult HIV/AIDS Confidential Case Report Form and Instruction	Modified
Perinatal HIV Exposure Reporting (PHER) Form and Instruction	Removed
Case Report Updates Form and Instruction	Modified
Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) Form and Instruction	Modified
Form 0920-0573 HIV Incidence Surveillance (HIS) Form and Instruction	Removed
Cluster Close-out Report Form and Instruction	Modified
Cluster Follow-up Report Form and Instruction	Modified
Initial Cluster Report Form and Instruction	Modified
Annual Reporting: Standards Evaluation Report (SER) Form and Instruction	Modified
Laboratory Updates Form and Instruction	Modified
Case Report Evaluations Form and Instruction	Modified
Att_10 Summary of Changes FINAL_08Feb22_SERv3_PWID _update_clean.pdf Supplementary Document	2022-09-08
Att_9_Project Determination.pdf Supplementary Document	2022-09-08
Att_8_Data Security and Confidentiality Guidelines.pdf Supplementary Document	2022-09-08
Att_7(b) NHSS_ Complete AoC_Final updated 102621 per amendment_CSpacket.pdf Supplementary Document	2022-09-08
Att_7(a) NHSS_ AoC Statement_FinalOct2019.pdf Supplementary Document	2022-09-08
Att_6(b) ATO.pdf Supplementary Document	2022-09-08
Att_6(a) PIA.pdf Supplementary Document	2022-09-08
Att_5 cdc-hiv-surveillance-report-2020-updated-vol-33.pdf Supplementary Document	2022-09-08
Att_4(f) Cluster Report Form Instructions updated 11052021_share.pdf Supplementary Document	2022-09-08
Att_4(e) DETECTING HIV TRANSMISSION CLUSTERS 2022 v1 (1).pdf Supplementary Document	2022-09-08
Att_4(d) D2C-Monitoring-and-Evaluation-Guidance _Jun21fin_508C_8.30.pdf Supplementary Document	2022-09-08
Att_4(c) DUPLICATE REVIEW 2022 v1.pdf Supplementary Document	2022-09-08
Att_4(b) PEDIATRIC HIV CASE REPORT FORM 2023 v2_PWID edit_clean.pdf Supplementary Document	2022-09-08
Att_4(a) ADULT HIV CONFIDENTIAL CASE REPORT FORM 2023 v2.pdf Supplementary Document	2022-09-08
Att_3(c) NHSS_dataelements_OMB_BG_KB_Clean_PWID edit_clean.pdf Supplementary Document	2022-09-08
Att_2(a) 60 Day FRN pub 4 -1-2022.pdf Supplementary Document	2022-09-07
Att_1_ Authorizing Legislation.pdf Supplementary Document	2022-09-07
SSB_08Aug22_clean.docx Supporting Statement B	2022-09-07
SSA_NHSS_31AUG22_clean.docx Supporting Statement A	2022-09-07

IC Document Collections

IC ID	Document Title	Status
7028	Adult HIV/AIDS Confidential Case Report Form and Instruction	Modified
46035	Perinatal HIV Exposure Reporting (PHER) Form and Instruction	Removed
46032	Case Report Updates Form and Instruction	Modified
46030	Pediatric HIV Confidential Case Report Form (with Perinatal HIV Exposure information) Form and Instruction	Modified
243727	HIV Incidence Surveillance (HIS) Form and Instruction	Removed
236513	Data De-duplication Activities Other-Technical Guidance for HIV Surveillance Programs: Duplicat	Modified
236512	Cluster Close-out Report Form and Instruction	Modified
236511	Cluster Follow-up Report Form and Instruction	Modified
236510	Initial Cluster Report Form and Instruction	Modified
236509	Investigation Reporting and Evaluation Other-Data to Care Reporting Guidance for PS18-1802 and PS20-201	Modified
220109	Annual Reporting: Standards Evaluation Report (SER) Form and Instruction	Modified
205249	Laboratory Updates Form and Instruction	Modified
205248	Case Report Evaluations Form and Instruction	Modified

ICR Details

OMB Control No:	ICR Reference No:
Status:	Previous ICR Reference No:
Agency/Subagency:	Agency Tracking No:
Title:
Type of Information Collection:	Common Form ICR:
Type of Review Request:	Date Received in OIRA:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	0	0	0	0	0	0
Annual Time Burden (Hours)	0	0	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion:

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion:

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods?

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.    

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.    

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

Is this ICR related to the Pandemic Response?

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Common Form ICR: 

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date:

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