VHF Contact Tracing Follow-Up Form - English

Surveillance Data Collections for Ebola Virus Disease in West Africa

OMB: 0920-1085

IC ID: 217263

Information Collection (IC) Details

View Information Collection (IC)

VHF Contact Tracing Follow-Up Form - English
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form None VHF Contact Tracing Follow-Up Form - English Att13 VHFContctTracngFollwUpForm ENG.docx None Yes Yes Fillable Fileable

Health Public Health Monitoring

 

171,960 0
   
Individuals or Households
 
   20 %

  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 171,960 0 171,960 0 0 0
Annual IC Time Burden (Hours) 180,558 0 180,558 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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