Leptospirosis Case Report

National Disease Surveillance Program

OMB: 0920-0009

IC ID: 207080

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Leptospirosis Case Report
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Leptospirosis Case Report Lepto_CRF_May2013.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

57 0
   
State, Local, and Tribal Governments
 
   50 %

  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 114 0 0 0 0 114
Annual IC Time Burden (Hours) 29 0 0 0 0 29
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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