EVD Contact Tracing Investigation Form

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

Documents and Forms

Document Name Document Type
EVD Contact Tracing Investigation Form Form and Instruction
EVD Contact Tracing Form - United States Att2 EVD Contact Tracing Form 20150123.docx Form and Instruction

Information Collection (IC) Details

IC Title:	EVD Contact Tracing Investigation 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	EVD Contact Tracing Form - United States	Att2 EVD Contact Tracing Form 20150123.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 System	FR Citation: 51 FR 42466

Number of Respondents: 53	Number of Respondents for Small Entity: 0

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	53	53
Annual IC Time Burden (Hours)	9	9
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.