Information Collection

0920-0004 Waterborne Diseases Outbreak 52.12

IC 178372 under ICR 201005-0920-006 · OMB 0920-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 52.12 0920-0004 Waterborne Diseases Outbreak 52.12 Form
CDC 52.12 Waterborne Disease Outbreak Report Revised CDC 52.12 NORS Waterborne Disease Transmission 05122008.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	0920-0004 Waterborne Diseases Outbreak 52.12	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 52.12	Waterborne Disease Outbreak Report	Revised CDC 52.12 NORS Waterborne Disease Transmission 05122008.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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