Information Collection

Rapid Response Survey -- Middle East Respiratory Syndrome-Coronavirus (MERS-CoV)

IC 210222 under ICR 201012-0910-003 · OMB 0910-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
QUESTIONNAIRE 1-23-14.docx	Other-Questionnaire
0500 OMB JUSTIFICATION 1-23-14.doc 0500 OMB JUSTIFICATION 1-23-14	IC Document

IC Title:

Rapid Response Survey -- Middle East Respiratory Syndrome-Coronavirus (MERS-CoV)

Agency IC Tracking Number:

IC Status: New

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
Other-Questionnaire			QUESTIONNAIRE 1-23-14.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	5,500	0	0	0	0	0
Annual IC Time Burden (Hours)	458	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0500 OMB JUSTIFICATION 1-23-14	0500 OMB JUSTIFICATION 1-23-14.doc	01/27/2014

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