Adult and Pediatric HIV/AIDS Confidential Case Reports for National HIV/AIDS Surveillance

Forms and Documents

Document Name	Status
Adult HIV/AIDS Confidential Case Report Form	Modified
Enhanced Perinatal Surveillance (EPS) Form	Modified
Case Report Updates Form	Modified
Pediatric HIV/AIDS Confidential Case Report Form	Modified
PCRF 19May2011.pdf Supplementary Document	2011-06-01
ACRF Changes HARS to eHARS_omb_fin26May11.docx Supplementary Document	2011-06-01
0920-0573_nonsubchange_26May11.docx Justification for No Material/Nonsubstantive Change	2011-06-01
0920-0573_att 4(d) EPS Sum of form changes_draft User Guide .pdf Supplementary Document	2009-11-30
0920-0573_att 4(c) VARHS Technical_Guidance.pdf Supplementary Document	2009-11-30
0920-0573_att 4(b)Technical_Guidance_HIV Incidence Surveillance.pdf Supplementary Document	2009-11-30
0920-0573_att 3(c)_eHARS Variables.doc Supplementary Document	2009-11-30
0920-0573_att 4(a) adult and ped instruct_Tech_Guidance_vol2.pdf Supplementary Document	2009-11-30

IC Document Collections

IC ID	Document Title	Status
7028	Adult HIV/AIDS Confidential Case Report Form	Modified
46035	Enhanced Perinatal Surveillance (EPS) Form	Modified
46034	VARHS - Variant, Atypical, and Resistant HIV Surveillance Data Elements Other-Data Elements	Modified
46033	HIV Incidence Surveillance Data Elements Other-Incidence Data Elements	Modified
46032	Case Report Updates Form	Modified
46030	Pediatric HIV/AIDS Confidential Case Report Form	Modified

ICR Details

OMB Control No: 0920-0573	ICR Reference No: 201106-0920-003
Status: Historical Active	Previous ICR Reference No: 200912-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Adult and Pediatric HIV/AIDS Confidential Case Reports for National HIV/AIDS Surveillance
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/03/2011
	Date Received in OIRA: 06/02/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	01/31/2013	01/31/2013
Responses	200,335	0	200,335
Time Burden (Hours)	51,311	0	51,311
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request to make minor changes to the adult and pediatric AIDS/HIV surveillance forms. The revised forms reflect the OMB approved eHARS data elements and one additional element.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: National Center for Health Statistics
   US Code: 42 USC 242b Name of Law: General Authority Respecting Research...
   US Code: 42 USC 242m Name of Law: General Provisions Respecting Effectiveness, Efficiency, and Quality of Health Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Pediatric HIV/AIDS Confidential Case Report	none	Pediatric Case Report Form
Adult HIV/AIDS Confidential Case Report	none	Adult Case Report Form
Case Report Updates	none, none	Adult HIV/AIDS Confidential Case Report ,   Pediatric HIV/AIDS Confidential Case Report
HIV Incidence Surveillance Data Elements
VARHS - Variant, Atypical, and Resistant HIV Surveillance Data Elements
Enhanced Perinatal Surveillance (EPS)	none	Enhanced Perinatal Surveillance

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ICR Summary of Burden

	Total Approved	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	200,335	200,335	0	0	0	0
Annual Time Burden (Hours)	51,311	51,311	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $61,445,689

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/02/2011

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