Information Collection

VHF Contact Tracing Follow-Up Form - English

IC 217263 under ICR 201505-0920-008 · OMB 0920-1085.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VHF Contact Tracing Follow-Up Form - English	Form
VHF Contact Tracing Follow-Up Form - English Att13 VHFContctTracngFollwUpForm ENG.docx	Form

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	VHF Contact Tracing Follow-Up Form - English	Att13 VHFContctTracngFollwUpForm ENG.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 171,960

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	171,960	171,960
Annual IC Time Burden (Hours)	180,558	180,558
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.