Information Collection

Cholera_Kenya

IC 217021 under ICR 201507-0920-005 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cholera_Kenya	Form and Instruction
Community Questionnaire Appendix 1 Community Questionnaire - English 6_12_15.doc	Form and Instruction
Healthcare Worker Questionnaire Appendix 2 Healthcare worker questionnaire - English.docx	Form and Instruction
LOI from MoH Kenya 03JUN2015.pdf LOI Kenya MoH	IC Document
Burden Estimate_EEI GenIC Cholera_Kenya.docx EEI Burden Estimate Cholera_Kenya	IC Document
1 GenIC Request Form - EEI Generic ICR_cholera kenya 2015 6_12_15_revised.docx EEI Request - Cholera_Kenya	IC Document

IC Title:

Cholera_Kenya

Agency IC Tracking Number:

0920-1011-15AQN

IC Status: Unchanged

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	Community Questionnaire	Appendix 1 Community Questionnaire - English 6_12_15.doc	None	No		Paper Only
Form and Instruction	None	Healthcare Worker Questionnaire	Appendix 2 Healthcare worker questionnaire - English.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemic Investigations Case Records

FR Citation: 51 FR 42466

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	183	183
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LOI Kenya MoH	LOI from MoH Kenya 03JUN2015.pdf	06/12/2015
EEI Burden Estimate Cholera_Kenya	Burden Estimate_EEI GenIC Cholera_Kenya.docx	06/12/2015
EEI Request - Cholera_Kenya	1 GenIC Request Form - EEI Generic ICR_cholera kenya 2015 6_12_15_revised.docx	06/13/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.