Case Report Form for Coccidioidomycosis

Enhanced Surveillance of Coccidioidomycosis in Low- and Non-Endemic States

OMB: 0920-1087

IC ID: 216654

Information Collection (IC) Details

View Information Collection (IC)

Case Report Form for Coccidioidomycosis 15UR
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Case Report for Coccidioidomycosis Attachment 4 CRF for cocci enhanced surveillance 4.15.15.docx No   Paper Only

Health Public Health Monitoring

 

145 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 145 0 145 0 0 0
Annual IC Time Burden (Hours) 48 0 48 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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