Attachment E Requesting State and Local Form

Attachment E State and Local Officials Questionaire.doc

Emergency Epidemic Investigations

Attachment E Requesting State and Local Form

OMB: 0920-0008

Document [doc]
Download: doc | pdf

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).


File Typeapplication/msword
Authormll1
Last Modified Bysxp1
File Modified2006-12-14
File Created2006-12-14

© 2024 OMB.report | Privacy Policy