Report of Verified Case of Tuberculosis (RVCT)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0026 can be found here:

Documents and Forms

Document Name Document Type
Report of Verified Case of Tuberculosis (RVCT) Form
Report of Verified Case of TB Attachment 3.pdf Form
Attachment 4.pdf Instructions to Respondents IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Verified Case of Tuberculosis (RVCT)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Report of Verified Case of TB	Attachment 3.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,960	-1,560	11,520
Annual IC Time Burden (Hours)	5,810	-910	6,720
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions to Respondents	Attachment 4.pdf	02/05/2014

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