Contact Exit Questionnaire

Ebola Transmission Dynamics among Household Contacts in West Africa: a Public Health Response Evaluation in Western Area, Sierra Leone

Documents and Forms

Document Name Document Type
Contact Exit Questionnaire Form and Instruction
Contact Exit Questionnaire Att5 Contact Exit Questnnre 20150118.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Contact Exit Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Contact Exit Questionnaire	Att5 Contact Exit Questnnre 20150118.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: 09-20-0113 Epi Invest Case Records	FR Citation: 51 FR 42466

Number of Respondents: 1,190	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,190	1,190
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.