Information Collection Request
Medical Report with Allegation of Human Immunodeficiency Virus (HIV) Infection--Adult and Child
ICR 202306-0960-004 · OMB 0960-0500 · Active
Forms and Documents
Document Name | Status |
|---|---|
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Supporting Statement A | 2022-09-02 |
Supporting Statement A | 2022-09-02 |
Justification for No Material/Nonsubstantive Change | 2023-06-26 |
Justification for No Material/Nonsubstantive Change | 2023-06-26 |
Form SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection
Supporting Statement - 0500 (Final).docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 9396 | Modified | ||
| 9396 | Modified | ||
| 187514 | Modified | ||
| 187514 | Modified |
Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) InfectionICR Details
| Status | Active |
|---|---|
| Agency/Subagency | SSA |
| OMB Control No | 0960-0500 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202204-0960-008 |
| Date Submitted to OIRA | 2023-06-30 |
| Requested Expiration Date | 1969-12-31 |