Information Collection

Mucormycosis_Kansas

IC 214409 under ICR 201501-0920-020 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mucormycosis_Kansas	Form and Instruction
Infection Prevention and Control Questions for Investiga Appendix 1 Infection Prevention and Control Questions.docx	Form and Instruction
Mucormycosis Data Abstraction Form Appendix 2 Data Abstraction Form.docx	Form and Instruction
1 GenIC Request Form - EEI Generic ICR_KS Mucor.docx Request for GenIC Approval	IC Document
0920-1011 GenIC Request 2015004_XXX Mucormycosis_KS.msg EEI GenIC Request Burden Table	IC Document
LOI_KS mucormycosis_REDACTED.pdf LOI - Kansas_Mucormycosis	IC Document

IC Title:

Mucormycosis_Kansas

Agency IC Tracking Number:

15IV

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	None	Infection Prevention and Control Questions for Investigation of Mucormycosis	Appendix 1 Infection Prevention and Control Questions.docx	None	No		Paper Only
Form and Instruction	None	Mucormycosis Data Abstraction Form	Appendix 2 Data Abstraction Form.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for GenIC Approval	1 GenIC Request Form - EEI Generic ICR_KS Mucor.docx	12/23/2014
EEI GenIC Request Burden Table	0920-1011 GenIC Request 2015004_XXX Mucormycosis_KS.msg	12/23/2014
LOI - Kansas_Mucormycosis	LOI_KS mucormycosis_REDACTED.pdf	12/23/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.