Information Collection

ABCs Case Report Form

IC 186327 under ICR 200808-0920-010 · OMB 0920-0802.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0802 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form no number ABCs Case Report Form	Form
no number Case Report Form Attachment 3_ABCs 2008.pdf	Form
Attachment 7_ABCs_CaseReportForm_Instructions_2008.doc Instructions for Case Report Form	IC Document

IC Title:

ABCs Case Report Form

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
Form	no number	Case Report Form	Attachment 3_ABCs 2008.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,090	8,090
Annual IC Time Burden (Hours)	2,697	2,697
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Case Report Form	Attachment 7_ABCs_CaseReportForm_Instructions_2008.doc	08/11/2008

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