Information Collection

Ebola Virus Disease Case Contact Questionnaire

IC 213620 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 Ebola Virus Disease Case Contact Questionnaire	Form and Instruction
0920-15CN Attachment L_Ebola Virus Disease Case Contact Questionna Attachment L_Ebola Virus Disease Case Contact Questionnaire.doc	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 L_Ebola Virus Disease Case Contact Questionnaire	Attachment L_Ebola Virus Disease Case Contact Questionnaire.doc		Yes	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 42166

Number of Respondents: 50

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	50	50
Annual IC Time Burden (Hours)	4	4
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.