Document
Attachment E Requesting State and Local Form
ICR 200612-0920-008 · OMB 0920-0008 · Object 1269501.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Attachment E Requesting State and Local Form |
| Author | mll1 |
| Last Modified By | Writer |
| File Modified | 2006-12-14 |
| File Created | 2026-10-16 |
| Conversion State | complete |
Extracted Text
OMB No: 0920-0008 Exp. Date XX/XX/2010 State and Local Officials Questionnaire Emergency Epidemic Investigations EPI AID No: ___________ Title of Investigation: Request for Assistance submitted: Response received from CDC: Investigative team arrived: Date of Investigation: Beginning: Ending: Were you satisfied with the promptness of the investigative team? Yes ________ No ________ If no, please explain. Recommendations from improvement in promptly responding to assistance request: Public reporting burden of this collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, MS D-74, Atlanta, Georgia 30333; ATTN PRA (0920-0008).