Information Collection

Title Malaria pre-travel advice: Knowledge and practices among US healthcare providers whose patients develop malaria (Interview Form 3

IC 191936 under ICR 201002-0920-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Title Malaria pre-travel advice: Knowledge and practices among US healthcare providers whose patients develop malaria (Interview Form 3	Form
3 Interview Form: Healthcare Provider Attachment 6_InterviewForm_HCP_3-5-10.doc	Form
Attachment 7_DataAnalysisTables.doc Attachment 7_DataAnalysisTables	IC Document

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	3	Interview Form: Healthcare Provider	Attachment 6_InterviewForm_HCP_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: 438

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	438	438
Annual IC Time Burden (Hours)	110	110
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 7_DataAnalysisTables	Attachment 7_DataAnalysisTables.doc	01/07/2010

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