Health Department Use and Application of CDC Drug Resistant TB Laboratory Services

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
ATTACHMENT C - Data Collection Instrument (MS Word Version).docx Other-WORD
ATTACHMENT D - Data Collection Instrument (Online PDF Version).pdf Other-WORD
TB Ref Lab- Supporting_Statement_A.docx TB Ref Lab- Supporting_Statement_A IC Document
TB Reb Lab- Supporting_Statement_B.docx TB Reb Lab- Supporting_Statement_B IC Document
ATTACHMENT A- TB in US 2011.pdf ATTACHMENT A- TB in US 2011 IC Document
ATTACHMENT B- Expert Consultations on RMT MDDR TB in US.docx ATTACHMENT B- Expert Consultations on RMT MDDR TB in US IC Document
ATTACHMENT E Advance Notification Email.docx ATTACHMENT E Advance Notification Email IC Document
ATTACHMENT F. Notification Email.docx ATTACHMENT F IC Document
ATTACHMENT G. Email Reminder (Day 4).docx.docx ATTACHMENT G IC Document
ATTACHMENT H. Email Reminder (Day 8).docx.docx ATTACHMENT H IC Document

Information Collection (IC) Details

IC Title:	Health Department Use and Application of CDC Drug Resistant TB Laboratory Services	Agency IC Tracking Number:

IC Status: New

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
Other-WORD			ATTACHMENT C - Data Collection Instrument (MS Word Version).docx		Yes	Yes	Fillable Printable
Other-WORD			ATTACHMENT D - Data Collection Instrument (Online PDF Version).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	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	60	0	0	0	0	0
Annual IC Time Burden (Hours)	15	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
TB Ref Lab- Supporting_Statement_A	TB Ref Lab- Supporting_Statement_A.docx	11/18/2013
TB Reb Lab- Supporting_Statement_B	TB Reb Lab- Supporting_Statement_B.docx	11/18/2013
ATTACHMENT A- TB in US 2011	ATTACHMENT A- TB in US 2011.pdf	11/18/2013
ATTACHMENT B- Expert Consultations on RMT MDDR TB in US	ATTACHMENT B- Expert Consultations on RMT MDDR TB in US.docx	11/18/2013
ATTACHMENT E Advance Notification Email	ATTACHMENT E Advance Notification Email.docx	11/18/2013
ATTACHMENT F	ATTACHMENT F. Notification Email.docx	11/18/2013
ATTACHMENT G	ATTACHMENT G. Email Reminder (Day 4).docx.docx	11/18/2013
ATTACHMENT H	ATTACHMENT H. Email Reminder (Day 8).docx.docx	11/18/2013

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