Symptom Monitoring Form

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

OMB: 0920-1045

IC ID: 214550

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

View Information Collection (IC)

Symptom Monitoring Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Symptom Monitoring Form Att6 Symptom Monitoring Form.docx None Yes Yes Fillable Fileable

Disaster Management Emergency Response

09-20-0113, Epidemic Investigation Case Record Systems Notice  51 FR 42466

53 0
   
Individuals or Households
 
   20 %

  Approved 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 2,226 0 2,226 0 0 0
Annual IC Time Burden (Hours) 186 0 186 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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