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Attachment 4 0920 0004 Change Request 0920 0004 9 18 08
ICR 201005-0920-006 · OMB 0920-0004 · Object 17760701.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Attachment 4 0920 0004 Change Request 0920 0004 9 18 08 |
| Author | bas1 |
| Last Modified By | Writer |
| File Modified | 2008-09-22 |
| File Created | 2026-07-22 |
| Conversion State | complete |
Extracted Text
Attachment 4 0920 0004 Change Request 9 22 08 HABISS Monthly Reporting Form --------------------------------------------------------------------------------------------------------------------- Name of State Agency: Name of Person Submitting Report: Date of Submission: Please fill out the cases entered this month. Use a “0” or “Don’t Know” when necessary. Do not leave any blanks. Please submit this report each month to Rebecca LePrell by e-mail ([email protected]) or fax, 770-488-3450. Sum (#) of New Cases Entered Sum (#) of Historical Cases Entered Human Illness Confirmed Human Illness Suspect Non HAB-related Human Illness Sum (#) of New Cases Entered Sum (#) of Historical Cases Entered Animal Illness Confirmed Animal Illness Suspect Non HAB-related Human Illness Name of HAB- Illness Investigated # of New Cases Entered (By Illness) # of Historical Cases Entered (By Illness) Anatoxin-a Poisoning Anatoxin-a(s) Poisoning Azaspiracid Poisoning (AZP) Brevetoxin Poisoning from Aerosols in Humans Brevetoxin Poisoning From Ingestion in Humans: Neurotoxic shellfish poisoning (NSP) Brevetoxin Poisoning From Ingestion in Animals: Food Web Brevetoxin Poisoning From Skin Contact (direct dermal and mucous membranes) Ciguatera Fish Poisoning Cylindrospermopsin Poisoning Diarrhetic shellfish poisoning (DSP) From Ingestion in Humans Domoic Acid Poisoning From Ingestion in Humans (Amnesic shellfish poisoning ASP) Domoic Acid Poisoning From Food Web in Animals Lyngbyatoxin Poisoning Microcystin Poisoning Nodularin Poisoning Palytoxin Poisoning From Ingestion in Humans Saxitoxin Poisoning From Ingestion in Humans (Paralytic shellfish poisoning) Saxitoxin Poisoning From Food Web in Animals Pectenotoxin Poisoning Tetrodotoxin Poisoning (pufferfish or fugu poisoning) Yessotoxin Poisoning