Information Collection

Health Care Worker EVD Exposure Risk - English

IC 217280 under ICR 201505-0920-008 · OMB 0920-1085.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health Care Worker EVD Exposure Risk - English	Form
Health Care Worker EVD Exposure Risk - English Att25 HCW.EVD.expriskreport ENG.pdf	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	Health Care Worker EVD Exposure Risk - English	Att25 HCW.EVD.expriskreport ENG.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: 2,455

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	2,455	2,455
Annual IC Time Burden (Hours)	1,228	1,228
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.