Congenital Syphilis (CS) Case Investigation and Report Form Territorial Health Agencies

Congenital Syphilis Case Investigation and Report Form

OMB: 0920-0128

IC ID: 46587

Information Collection (IC) Details

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Congenital Syphilis (CS) Case Investigation and Report Form Territorial Health Agencies
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0128 Congenital Syphilis Case Investigation and Report Form 0920-0128_Attachment3c RvsdCSform2.pdf Yes Yes Printable Only

Health Public Health Monitoring

 

3 0
   
Federal Government
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 33 0 -87 0 0 120
Annual IC Time Burden (Hours) 11 0 -49 0 0 60
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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