Information Collection

Malaria pre-travel advice: Knowledge and practices among US healthcare providers whose patients develop malaria (Interview Form 1)

IC 191934 under ICR 201002-0920-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Malaria pre-travel advice: Knowledge and practices among US healthcare providers whose patients develop malaria (Interview Form 1)	Form
1 IInterview Form: Patients≥18 years old Attachment 4_InterviewForm_18over_3-5-10.doc	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	1	IInterview Form: Patients≥18 years old	Attachment 4_InterviewForm_18over_3-5-10.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems"

FR Citation: 74 FR 57683

Number of Respondents: 350

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	350	350
Annual IC Time Burden (Hours)	88	88
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.