CDC is requesting a non-substantive change request to add four forms, one which was previously approved under the Epi-Aid Mechanism, 0920-1011 and expired 12/31/14: Healthcare Worker - Ebola Virus Disease Exposure Risk Report (CDC/WHO). There are three new forms: Healthcare Worker - Ebola Virus Disease Exposure Risk Report (CDC/WHO) â French, Healthcare Worker - Ebola Virus Disease Investigation Questionnaire â Liberia, and Healthcare Worker - Ebola Virus Disease Exposure Risk Report - Sierra Leone.
WHO has declared the Ebola outbreak in West Africa to be an international public health emergency. The 2014 Ebola outbreak is unprecedented and the first in West Africa. CDC is currently assisting with the investigation, by taking active steps to respond to the rapidly changing situation internationally and domestically by working with other U.S. government agencies, the World Health Organization, and other domestic and international partners to identify sources and risk factors for Ebola infection in order to implement prevention and control measures. The epidemiological objectives are to maintain a centralized database for data collected from all outbreak sites, domestic and international to assist in contact tracing, case report collection, and patient or family interviews.
US Code:
42 USC 241
Name of Law: Public Health Service Act
CDC is requesting a non-substantive change request to add four forms, one which was previously approved under the Epi-Aid Mechanism, 0920-1011 and expired 12/31/14: Healthcare Worker - Ebola Virus Disease Exposure Risk Report (CDC/WHO). There are three new forms: Healthcare Worker - Ebola Virus Disease Exposure Risk Report (CDC/WHO) â French, Healthcare Worker - Ebola Virus Disease Investigation Questionnaire â Liberia, and Healthcare Worker - Ebola Virus Disease Exposure Risk Report - Sierra Leone.
The purpose of these forms is to investigate cases of Ebola Virus Disease in health care workers to determine what facility-based risk factors may have led to their infection, to allow for corrective changes in health care facility infection prevention practices and to contribute to epidemiologic understanding of the Ebola epidemic in order to combat it more effectively. These forms were developed through a consultative process between the national Ministry of Health and implementing partners, based on experience piloting earlier versions. CDC was involved as a consultant in its development. The request for multiple forms with small differences for each country in which they will be deployed reflects the reality on the ground.
The total approved hours in this collection is 54,282.
$339,695
No
No
No
No
No
Uncollected
Catina Conner 4046394775
Reginfo record details
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Healthcare Worker- Ebola Virus Disease Exposure Risk Report - Sierra Leone