Information Collection

Preparedness for Persons under Investigation for Ebola Virus Disease

IC 213377 under ICR 201402-0920-018 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.