Information Collection

Viral Hemorrhagic Fever Contact Listing Form (Liberia)

IC 213618 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 Viral Hemorrhagic Fever Contact Listing Form (Liberia)	Form and Instruction
0920-15CN Attachment K_Viral Hemorrhagic Fever Contact Listing For Attachment K_Viral Hemorrhagic Fever Contact Listing Form_Liberia.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	Attachment K_Viral Hemorrhagic Fever Contact Listing Form_Liberia	Attachment K_Viral Hemorrhagic Fever Contact Listing Form_Liberia.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

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	12,000	12,000
Annual IC Time Burden (Hours)	3,000	3,000
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.