Information Collection

US/WHO International Clinical Network Ebola Virus Disease Clinical Data Collection Tool

IC 216874 under ICR 201506-0920-002 · OMB 0920-1069.

Documents and Forms

Document Name Document Type
US/WHO International Clinical Network Ebola Virus Disease Clinical Data Collection Tool Form
US/WHO Clinical Network EVD Data Collection Tool AppndxC US-WHO ClinNetworkEVDDataCollTool 20150604.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	US/WHO International Clinical Network Ebola Virus Disease Clinical Data Collection Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	US/WHO Clinical Network EVD Data Collection Tool	AppndxC US-WHO ClinNetworkEVDDataCollTool 20150604.xlsx	None	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Epidemic Investigation Case Records	FR Citation: 51 FR 42466

Number of Respondents: 21	Number of Respondents for Small Entity: 18

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.