Information Collection

Weekly Active Monitoring - web

IC 215921 under ICR 201503-0920-019 · OMB 0920-1066.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Weekly Active Monitoring Tracking Report Weekly Active Monitoring - web	Form
Weekly Active Monitoring Tracking Report AttF - Weekly AM Report Low not zero EVD Risk - Web Form.docx	Form
AttE-Weekly AM Report Word 051415.docx Weekly Active Monitoring Report - word	IC Document
AttG - Weekly Notification Email-revise05192015.docx Weekly Notification Email	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	none				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,612	1,612
Annual IC Time Burden (Hours)	349	349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Weekly Active Monitoring Report - word		05/20/2015
Weekly Notification Email		05/20/2015

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].