Information Collection

Adverse Events to LTBI Treatment (AELT) - Physicians

IC 183193 under ICR 200712-0920-013 · OMB 0920-0773.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0773 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A4_AELT_Instrument.doc	Other-WORD
A5_Guidelines.doc A5_Guidelines	IC Document

IC Title:

Adverse Events to LTBI Treatment (AELT) - Physicians

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-WORD					No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A5_Guidelines		11/20/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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