Information Collection

Survey of Appropriate and Timely Diagnosis of Infectious Diseases

IC 191031 under ICR 200910-2900-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0476a Survey of Appropriate and Timely Diagnosis of Infectious Diseases	Form
VA Form 10-0476a Survey of Diagnosis of Infectious Diseases (Malaria) VA Form 10-0476a (M).pdf	Form
VA Form 10-0476 Survey of Diagnosis of Infectious Diseases VA_Form_10-0476_(L).pdf	Form

IC Title:

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	VA Form 10-0476a	Survey of Diagnosis of Infectious Diseases (Malaria)	VA Form 10-0476a (M).pdf		No		Paper Only
Form	VA Form 10-0476	Survey of Diagnosis of Infectious Diseases	VA_Form_10-0476_(L).pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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