VHF Case Investigation (Short Form) - Portuguese

Surveillance Data Collections for Ebola Virus Disease in West Africa

Documents and Forms

Document Name Document Type
VHF Case Investigation (Short Form) - Portuguese Form and Instruction
VHF Case Investigation (Short Form) - Portuguese Att3 VHFCaseInvstgnShortForm 20141008 PORT.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	VHF Case Investigation (Short Form) - Portuguese	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	VHF Case Investigation (Short Form) - Portuguese	Att3 VHFCaseInvstgnShortForm 20141008 PORT.pdf	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 176	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	176	176
Annual IC Time Burden (Hours)	29	29
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.