Symptom Monitoring Form - Environmental Lab Personnel

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

OMB: 0920-1045

IC ID: 214556

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Symptom Monitoring Form - Environmental Lab Personnel
 
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

300 300
   
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 12,600 0 12,600 0 0 0
Annual IC Time Burden (Hours) 1,050 0 1,050 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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