Line Listing

Creation of State and Metropolitan Area Based Surveillance Projects for Amyotrophic Lateral Sclerosis (ALS)

Attachment 4a-Line Listing

Line Listing

OMB: 0923-0043

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Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx






Line Listing (Record Keeping)

Each medical provider reporting source should keep a line listing of individuals diagnosed with or thought to have ALS along with information on whether or not the case was reported and if not, the reason. Contract surveillance staff will be in frequent contact with physician’s offices and will be available to assist with this activity.



Public reporting burden of this collection of information is estimated to average 1 hour including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the data collection of information. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0923-XXXX).


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authorwek1
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File Created2021-02-01

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