Information Collection

MPEP Mycobacterium Tuberculosis Results

IC 46480 under ICR 201304-0920-020 · OMB 0920-0600.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0600 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MPEP Mycobacterium Tuberculosis Results	Form and Instruction
Attachment G: MPEP Mycobacterium Tuberculosis Results Att G MPEP M tuberculosis worksheet.docx	Form and Instruction
Att E Preshipment Email_page 1.docx Att E Preshipment Email_page 1	IC Document
Att F Instructions for particpants.docx Att F Instructions for particpants	IC Document
Att I Reminder Email.docx Att I Reminder Email	IC Document
Att J Reminder Telephone Script.docx Att J Reminder Telephone Script	IC Document
Att K Aggregate Report Letter.docx Att K Aggregate Report Letter	IC Document
Att L Final Aggregate Report.pdf Att L Final Aggregate Report	IC Document

IC Title:

MPEP Mycobacterium Tuberculosis Results

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Attachment G: MPEP Mycobacterium Tuberculosis Results	Att G MPEP M tuberculosis worksheet.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 93

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	186	-78	264
Annual IC Time Burden (Hours)	93	-39	132
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att E Preshipment Email_page 1	Att E Preshipment Email_page 1.docx	04/22/2013
Att F Instructions for particpants	Att F Instructions for particpants.docx	04/22/2013
Att I Reminder Email	Att I Reminder Email.docx	04/22/2013
Att J Reminder Telephone Script	Att J Reminder Telephone Script.docx	04/22/2013
Att K Aggregate Report Letter	Att K Aggregate Report Letter.docx	04/22/2013
Att L Final Aggregate Report	Att L Final Aggregate Report.pdf	04/22/2013

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