Congenital Syphilis Case Investigation and Report Form

Congenital Syphilis Case Investigation and Report Form

OMB: 0920-0128

IC ID: 6642

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Congenital Syphilis Case Investigation and Report Form
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CDC-73.126 Yes Yes


    

65 0
   
State, Local, and Tribal Governments
 
   60 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 -500 0 0 1,000
Annual IC Time Burden (Hours) 130 0 -130 0 0 260
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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