Information Collection

Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Nurse

IC 213551 under ICR 201410-0920-024 · OMB 0920-0773.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0773 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Nurse	Form
Reporting Severe Adverse Events Associated with Treatmen Att 5 AdverseEvents Nurse LTBI NSSAE.docx	Form

IC Title:

Reporting Severe Adverse Events (Hospitalization or Death) Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Nurse

Agency IC Tracking Number:

Is this a Common Form? No

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	Reporting Severe Adverse Events Associated with Treatment of Latent Tuberculosis Infection (LTBI) - Nurse	Att 5 AdverseEvents Nurse LTBI NSSAE.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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