Viral Hemorrhagic Fever Case Investigation Form (Short Version Liberia)

2014 Emergency Response to Ebola in West Africa: Data Collection for Assisting Foreign and International Entities to Conduct Public Health Activities

OMB: 0920-1033

IC ID: 213614

Information Collection (IC) Details

View Information Collection (IC)

Viral Hemorrhagic Fever Case Investigation Form (Short Version Liberia) 0920-15CN
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-15CN Attachment G_Viral Hemorrhagic Fever Case Investigation Form_Short Version_Liberia Attachment G_Viral Hemorrhagic Fever Case Investigation Form_Short Version_Liberia.pdf Yes No Fillable Printable

Health Illness Prevention

Ebola Emergency Investigation Case Records System Notice  51 FR 42466

4,000 0
   
Individuals or Households
 
   0 %

  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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 667 0 0 0 0 667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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