Information Collection

Viral Hemorrhagic Fever Contact Tracing Follow-Up Form

IC 213619 under ICR 201410-0920-027 · OMB 0920-1033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1033 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-15CN Viral Hemorrhagic Fever Contact Tracing Follow-Up Form	Form and Instruction
0920-15CN Attachment N_Viral Hemorrhagic Fever Contact Tracing Fol Attachment N_Viral Hemorrhagic Fever Contact Tracing Follow-Up Form.docx	Form and Instruction

IC Title:

Viral Hemorrhagic Fever Contact Tracing Follow-Up Form

Agency IC Tracking Number:

0920-15CN

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 and Instruction	0920-15CN	Attachment N_Viral Hemorrhagic Fever Contact Tracing Follow-Up Form	Attachment N_Viral Hemorrhagic Fever Contact Tracing Follow-Up Form.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Ebola Emergency Investigation Case Records Systems Notice

FR Citation: 51 FR 42466

Number of Respondents: 12,000

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	252,000	252,000
Annual IC Time Burden (Hours)	42,000	42,000
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.