OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Hepatitis Testing and Linkage to Care Monitoring and Evaluation System

ICR 201301-0920-006 · OMB 0920-0959 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Program-level Data Form and Instruction Modified Repair queued
Test-level Data Form and Instruction Modified Available
SuppState B Clean.doc Supporting Statement B Uploaded 2013-03-21 Available
Att9 970_AOC Approval_2012.pdf Supplementary Document Uploaded 2013-01-10 Available
Att8 RulesOfBehavior - Users.docx Supplementary Document Uploaded 2013-01-10 Available
Att7 RulesOfBehavior - Administrator.docx Supplementary Document Uploaded 2013-01-10 Available
Att6 Agencies and Persons Consulted.docx Supplementary Document Uploaded 2013-01-10 Available
Att3 Goals_Objectives Table.docx Supplementary Document Uploaded 2013-01-10 Available
Att2 60 Day FRN Published.PDF Supplementary Document Uploaded 2013-01-10 Available
Att1 Auth Legis.pdf Supplementary Document Uploaded 2013-01-10 Available
SuppState A Clean.doc Supporting Statement A Uploaded 2013-03-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
204800 Program-level Data Form and Instruction Modified
204799 Test-level Data Form and Instruction Modified
ICR Details
0920-0959 201301-0920-006
Historical Active 201211-0920-007
HHS/CDC
Hepatitis Testing and Linkage to Care Monitoring and Evaluation System
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/22/2013
Retrieve Notice of Action (NOA) 01/17/2013
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
640 0 0
6,000 0 0
0 0 0
The Hepatitis Testing and Linkage to Care Monitoring and Evaluation System is a web-bsed data system to collect standardized, non-identifying, client- and test-level hepatitis testing information from funded testing sites. The data will be used to monitor and evaluate the implementation of hepatitis testing and linkage to care activities and to collect and report on required program performance indicators.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 34952 06/12/2012
77 FR 65553 10/29/2012
No
  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 640 0 0 640 0 0
Annual Time Burden (Hours) 6,000 0 0 6,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$563,279
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Tony Richardson 404 639-4965 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/17/2013