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2014012-XXX Resp Illness UC_CA

ICR 201501-0920-020 · OMB 0920-1011 · Object 53023801.

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	2014012-XXX Resp Illness UC_CA
Author	CDC User
Last Modified By	Writer
File Modified	2014-07-12
File Created	2026-10-30
Conversion State	complete

Extracted Text

Form Approved
OMB No. 0920-1011
Exp. Date 03/31/2017














Interview Form































Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333; ATTN: PRA (0920-1011)




















Prospective Pneumonia Surveillance Form