Information Collection

Viral Hemorrhagic Fever Case Investigation Form (Sierra Leone)

IC 213612 under ICR 201501-0920-017 · OMB 0920-1033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-15CN Attachment E_Viral Hemorrhagic Fever Case Investigation Form_Sierra Leone Viral Hemorrhagic Fever Case Investigation Form (Sierra Leone)	Form and Instruction
0920-15CN Attachment E_Viral Hemorrhagic Fever Case Investigation Attachment E_Viral Hemorrhagic Fever Case Investigation Form_Sierra Leone.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-15CN

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-15CN				No		Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Ebola Emergency Investigation Case Records System Notice

FR Citation: 51 FR 42466

Number of Respondents: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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