Information Collection

Questionnaires for State Epidemiologists Reporting Q Fever (Coxiella burnetii) and for the State Laboratories Testing for Q Fever

IC 6977 under ICR 200110-0920-001 · OMB 0920-0529.

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IC Title:

Questionnaires for State Epidemiologists Reporting Q Fever (Coxiella burnetii) and for the State Laboratories Testing for Q Fever

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

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