EVD Case Contact Questionnaire - French

Surveillance Data Collections for Ebola Virus Disease in West Africa

OMB: 0920-1085

IC ID: 217273

Documents and Forms
Information Collection (IC) Details

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EVD Case Contact Questionnaire - French
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None EVD Case Contact Questionnaire - French Att18 EVDCaseContctQx FRNCH.pdf None Yes Yes Fillable Fileable

Health Public Health Monitoring

 

112,470 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 112,470 0 112,470 0 0 0
Annual IC Time Burden (Hours) 9,373 0 9,373 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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