Congenital Syphilis (CS) Case Investigation and Report Form: Local Health Department

Congenital Syphilis Case Investigation and Report Form

OMB: 0920-0128

IC ID: 6642

Information Collection (IC) Details

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Congenital Syphilis (CS) Case Investigation and Report Form: Local Health Department
 
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 (CS) Case Investigation and Report Form 0920-0128_Attachment3b CSform2.pdf Yes Yes Fillable Printable

Health Public Health Monitoring

 

10 0
   
State, Local, and Tribal Governments
 
   100 %

  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 110 0 -290 0 0 400
Annual IC Time Burden (Hours) 37 0 -63 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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