Preparedness for Persons under Investigation for Ebola Virus Disease

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Preparedness for Persons under Investigation for Ebola Virus Disease Form
Assessment on Ebola Inquiries and Preparedness PUI- B- Instrument Web.pdf Form
PUI-SSB.docx Supporting Statement B IC Document
PUI- A- Instrument Word.doc Assessment on Ebola Inquiries - word IC Document
PUI-SSA.docx Supporting Statement A IC Document
PUI- C- Notification Email.docx Notification Email IC Document
PUI- D- Reminder Day 3.DOCX Reminder Email IC Document
PUI-E-Reminder Day 6.DOCX Second Reminder Email IC Document

Information Collection (IC) Details

IC Title:	Preparedness for Persons under Investigation for Ebola Virus Disease	Agency IC Tracking Number:	15AJ

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	Assessment on Ebola Inquiries and Preparedness	PUI- B- Instrument Web.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	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
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement B	PUI-SSB.docx	10/06/2014
Assessment on Ebola Inquiries - word	PUI- A- Instrument Word.doc	10/06/2014
Supporting Statement A	PUI-SSA.docx	10/06/2014
Notification Email	PUI- C- Notification Email.docx	10/06/2014
Reminder Email	PUI- D- Reminder Day 3.DOCX	10/06/2014
Second Reminder Email	PUI-E-Reminder Day 6.DOCX	10/06/2014

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