Information Collection

US-WHO Clinical Network Ebola Virus Disease Clinical Data Collection Tool

IC 214540 under ICR 201501-0920-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
US-WHO Clinical Network Ebola Virus Disease Clinical Data Collection Tool	Form and Instruction
US-WHO INTERNATIONAL CLINICAL NETWORK EBOLA VIRUS DISEAS AppndxC US-WHO ClinNetworkEVDDataCollTool 20150108.xlsx	Form and Instruction

IC Title:

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 and Instruction	None	US-WHO INTERNATIONAL CLINICAL NETWORK EBOLA VIRUS DISEASE CLINICAL DATA COLLECTION TOOL	AppndxC US-WHO ClinNetworkEVDDataCollTool 20150108.xlsx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-20-0113, Epidemic Case Records HHS/CDC

FR Citation: 51 FR 42466

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	23	23
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.