Monkeypox_ROC

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Monkeypox_ROC Form
Survey iin English Appendix 1a. Risk Factor Assessment_French.doc Form
Survey in French Appendix 1a. Risk Factor Assessment_French.doc Form
2015010-XXX_Monkeypox_Congo.docx Request for Approval IC Document
Invitation Letter - translated.docx Invitation Letter Translated IC Document
Invitation letter_6 24 2015.jpg Invitation Letter in French IC Document

Information Collection (IC) Details

IC Title:	Monkeypox_ROC	Agency IC Tracking Number:	15AUD

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR Public Health Service Act (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Survey iin English	Appendix 1a. Risk Factor Assessment_French.doc		No		Paper Only
Form	none	Survey in French	Appendix 1a. Risk Factor Assessment_French.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0113 Epidemic Investigation Case Records	FR Citation: 51 FR 4246

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	2015010-XXX_Monkeypox_Congo.docx	07/08/2015
Invitation Letter Translated	Invitation Letter - translated.docx	07/08/2015
Invitation Letter in French	Invitation letter_6 24 2015.jpg	07/08/2015

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