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Federal forms, ICRs, and supporting documents

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Healhcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO) - French

IC 214671 under ICR 201501-0920-017 · OMB 0920-1033.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Healhcare Worker-Ebola Virus Disease Exposure Risk Report (CDC/WHO) - French 0920-103315LC
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1033 Att B HCW.EVD.expriskreport_WestAfrica v10 French Att B HCW.EVD.expriskreport_WestAfrica v10 French.pdf No   Fillable Printable
Form and Instruction 0920-1033 Att B1 HCW.EVD.expriskreport_WestAfrica v10 Eng Translation Att B1 HCW.EVD.expriskreport_WestAfrica v10 Eng Translation.doc No   Fillable Printable

Health Public Health Monitoring

 

300 100
   
Private Sector Businesses or other for-profits
 
   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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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