Information Collection

MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet

IC 46480 under ICR 201003-0920-014 · OMB 0920-0600.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0600 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet	Form
Results Worksheet 0920-0600 Attachment 4c Gen Instruction and Results Worksheet (2).doc	Form
0920-0600 Attachment 4d NTM Case History Form.doc Case history example	IC Document
0920-0600 Attachment 4a Pre-Shipment Letter.doc Pre-shipment letter	IC Document
0920-0600 Attachment 4b Shipment and Password Letter.doc Shipment password letter	IC Document
0920-0600 Attachment 4ei Reminder Email.doc Reminder email	IC Document
0920-0600 Attachment 4eii Phone Script.doc Reminder telephone script	IC Document
0920-0600 Attachment 4f Prelim Results Letter.doc Preliminary report	IC Document
0920-0600 Attachment 4g Aggregate Results Letter.doc Aggregate report letter	IC Document

IC Title:

MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Results Worksheet	0920-0600 Attachment 4c Gen Instruction and Results Worksheet (2).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	264	-66	330
Annual IC Time Burden (Hours)	132	-33	165
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Case history example	0920-0600 Attachment 4d NTM Case History Form.doc	12/16/2009
Pre-shipment letter	0920-0600 Attachment 4a Pre-Shipment Letter.doc	12/16/2009
Shipment password letter	0920-0600 Attachment 4b Shipment and Password Letter.doc	12/16/2009
Reminder email	0920-0600 Attachment 4ei Reminder Email.doc	12/16/2009
Reminder telephone script	0920-0600 Attachment 4eii Phone Script.doc	12/16/2009
Preliminary report	0920-0600 Attachment 4f Prelim Results Letter.doc	12/16/2009
Aggregate report letter	0920-0600 Attachment 4g Aggregate Results Letter.doc	12/16/2009

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