Information Collection

The National Institute of Allergy and Infectious Diseases, Pan-American Health Organization, and World Health Organization, Gaps and Opportunities in Chikungunya Research: Expert Consultation on Chiku

IC 217622 under ICR 201212-0925-001 · OMB 0925-0668.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 The National Institute of Allergy and Infectious Diseases, Pan-American Health Organization, and World Health Organization, Gaps and Opportunities in Chikungunya Research: Expert Consultation on Chiku	Form and Instruction
1 Survey Screenshots OGR Chikungunya Survey - Online Survey Screenshots_v4.docx	Form and Instruction
2 Survey OGR Chikungunya Survey 7 24 2015.docx	Form and Instruction
Fast Track Template 2015_NIAID_OGR Chikungunya -SPEB.doc Fast-Track Template	IC Document

Information Collection (IC) Details

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IC Title:

The National Institute of Allergy and Infectious Diseases, Pan-American Health Organization, and World Health Organization, Gaps and Opportunities in Chikungunya Research: Expert Consultation on Chiku

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
Form and Instruction	1	Survey Screenshots	OGR Chikungunya Survey - Online Survey Screenshots_v4.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Survey	OGR Chikungunya Survey 7 24 2015.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast-Track Template	Fast Track Template 2015_NIAID_OGR Chikungunya -SPEB.doc	07/27/2015

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