Information Collection

Ebola Sexual Transmission Investigation Form - English

IC 217276 under ICR 201505-0920-008 · OMB 0920-1085.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Ebola Sexual Transmission Investigation Form - English	Form and Instruction
Ebola Sexual Transmission Investigation Form - English Att21 SexualTransmssnAdltCase ENG.docx	Form and Instruction

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 and Instruction	None	Ebola Sexual Transmission Investigation Form - English	Att21 SexualTransmssnAdltCase 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: 3,439

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	3,439	3,439
Annual IC Time Burden (Hours)	1,720	1,720
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.