Ebola Virus Disease Person Under Investigation (PUI) Form

Ebola Virus Disease in the United States:CDC Support for Case and Contact Investigation

Documents and Forms

Document Name Document Type
Ebola Virus Disease Person Under Investigation (PUI) Form Form and Instruction
Person Under Investigation (PUI) for Ebola Form - United Att1b EVD Person Under Investigation Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ebola Virus Disease Person Under Investigation (PUI) Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Person Under Investigation (PUI) for Ebola Form - United States	Att1b EVD Person Under Investigation Form.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: 09-20-0113, Epidemic Investigation Case Record Systems Notice	FR Citation: 51 FR 42466

Number of Respondents: 150	Number of Respondents for Small Entity: 8

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.