Information Collection

Requesting Laboratory Input to Support Ebola Response

IC 212941 under ICR 201402-0920-004 · OMB 0920-0881.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0881 can be found here:

Documents and Forms

Document Name Document Type
Requesting Laboratory Input to Support Ebola Response Form
Data Call Instrument Data Call Instrument.docx Form
SS B Supporting Statement.docx Supporting Statement Part B IC Document
SS A Data_Calls 8-26-14.doc Supporting Statement Part A IC Document
Attachment 1.docx Ebola Response Data Call Instrument IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Requesting Laboratory Input to Support Ebola Response	Agency IC Tracking Number:	14AXL

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
Form	none	Data Call Instrument	Data Call Instrument.docx		Yes	Yes	Fillable Fileable

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: 1

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part B	SS B Supporting Statement.docx	09/03/2014
Supporting Statement Part A	SS A Data_Calls 8-26-14.doc	09/04/2014
Ebola Response Data Call Instrument	Attachment 1.docx	09/04/2014

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