Bsi_ca

Emergency Epidemic Investigation Data Collections - Expedited Reviews

OMB: 0920-1011

IC ID: 213101

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

BSI_CA 14AYU
 
Unchanged
 
Voluntary
 
42 CFR USC 301 [241]  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Chart Abstraction Chart Abstraction Form.doc No   Paper Only
Form none Outpatient Dialysis Practices Survey Outpatient Dialysis Center Practices Survey.docx No   Paper Only
Form none Reprocessing Observation Checklist Reprocessing Observation Checklist.docx No   Paper Only

Health Public Health Monitoring

09-20-0113 Epidemic Investigation Case Records HHS/CDC  51 FR 42466

26 0
   
State, Local, and Tribal Governments
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 26 0 0 0 0 26
Annual IC Time Burden (Hours) 85 0 0 0 0 85
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Letter of Invitation Letter of Invite.docx 09/12/2014
Supporting Statement 2014017_XXX_BSI_CA.docx 09/15/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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