Medical Report with Allegation of Human Immunodeficiency Virus (HIV) Infection--Adult and Child

ICR 202306-0960-004

OMB: 0960-0500

Federal Form Document

Forms and Documents

Document Name	Status
Form SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
Form SSA-4814 Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
Form SSA-4815 Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
Form SSA-4815 Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
Supporting Statement - 0500 (Final).docx Supporting Statement A	2022-09-02
Supporting Statement - 0500 (Final).docx Supporting Statement A	2022-09-02
0960-0500 Justification for a Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2023-06-26
0960-0500 Justification for a Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2023-06-26

IC Document Collections

IC ID	Document Title	Status
9396	Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
9396	Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
187514	Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified
187514	Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection Form and Instruction	Modified