Information Collection

ABCs Case Report Form

IC 186327 under ICR 201004-0920-007 · OMB 0920-0802.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ABCs Case Report Form	Form
ABC Surveillance Case Report Attachment 2_ABCs 2010 CRF.pdf	Form
Attachment 7_ABCs_CaseReportForm_Instructions_2008.doc Instructions for Case Report Form	IC Document

IC Title:

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	ABC Surveillance Case Report	Attachment 2_ABCs 2010 CRF.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Previously Approved
Annual Number of Responses for this IC	8,090	8,090
Annual IC Time Burden (Hours)	2,697	2,697
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Case Report Form	Attachment 7_ABCs_CaseReportForm_Instructions_2008.doc	08/11/2008

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