Information Collection

Ebola_TX

IC 213323 under ICR 201311-0920-016 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Ebola_TX	Form and Instruction
Appendix 1 - Ebola Case Investigation Form Appendix 1. Ebola_Case Investigation Form.pdf	Form
Appendix 2 - Ebola Case Contact Questionnaire Appendix 2. Ebola_Case Contact Questionnaire.pdf	Form and Instruction
LOI.pdf Letter of Invitation - TDSHS	IC Document
2014020-XXX_Ebola_Texas[1].docx Request Letter	IC Document

IC Title:

Ebola_TX

Agency IC Tracking Number:

15AA

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	None	Appendix 2 - Ebola Case Contact Questionnaire	Appendix 2. Ebola_Case Contact Questionnaire.pdf	None	No		Paper Only
Form	None	Appendix 1 - Ebola Case Investigation Form	Appendix 1. Ebola_Case Investigation Form.pdf	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 76

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	76	76
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation - TDSHS	LOI.pdf	10/01/2014
Request Letter	2014020-XXX_Ebola_Texas[1].docx	10/02/2014

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