Information Collection

Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015

IC 218802 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⚠️ Notice: This information collection may be referencing outdated material.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
Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015	Form and Instruction
Community Suyrvey - English Appendix 1a - Community Survey - English.doc	Form and Instruction
Community Survey - French Appendix 1b - Community Survey - French.doc	Form and Instruction
Medical Providers Interview Survey - English Appendix 2a - Medical Providers Interview Survey - English edit .doc	Form and Instruction
Medical Providers Interview Survey - French Appendix 2b - Medical Providers Interview Survey - French edits-.doc	Form and Instruction
Rabies Official Interview Survey - English Appendix 3a - Rabies Official Interview Survey - English edits.doc	Form and Instruction
Rabies Official Interview Survey - French Appendix 3b - Rabies Official Interview Survey - French -.doc	Form and Instruction
Public Health Official Interview Survey - English Appendix 4a - Public Health Official Interview Survey - English.doc	Form and Instruction
Public Health Official Interview Survey - French Appendix 4b - Public Health Official Interview Survey - French - edit.doc	Form and Instruction
LOI_Haiti.pdf Letter of Invitation	IC Document
2016XXX-XXX Rabies_Haiti.docx GenIC Request Rabies_Haiti	IC Document
0920-1011 GenIC Request 2016002-XXX Rabies_Haiti.msg Burden Hour Request - email	IC Document

IC Title:

Undetermined risk factors associated with increase in bites from rabid dogs, resulting in at least one human death, Gonaives, Haiti, 2015

Agency IC Tracking Number:

0920-1011

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?	Electronic Capability
Form and Instruction	NA	Community Suyrvey - English	Appendix 1a - Community Survey - English.doc	NA	No	Paper Only
Form and Instruction	NA	Community Survey - French	Appendix 1b - Community Survey - French.doc	NA	No	Paper Only
Form and Instruction	NA	Medical Providers Interview Survey - English	Appendix 2a - Medical Providers Interview Survey - English edit .doc	NA	No	Paper Only
Form and Instruction	NA	Medical Providers Interview Survey - French	Appendix 2b - Medical Providers Interview Survey - French edits-.doc	NA	No	Paper Only
Form and Instruction	NA	Rabies Official Interview Survey - English	Appendix 3a - Rabies Official Interview Survey - English edits.doc	NA	No	Paper Only
Form and Instruction	NA	Rabies Official Interview Survey - French	Appendix 3b - Rabies Official Interview Survey - French -.doc	NA	No	Paper Only
Form and Instruction	NA	Public Health Official Interview Survey - English	Appendix 4a - Public Health Official Interview Survey - English.doc	NA	No	Paper Only
Form and Instruction	NA	Public Health Official Interview Survey - French	Appendix 4b - Public Health Official Interview Survey - French - edit.doc	NA	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0113 Epidemic Investigation Case Records Systems Notice

FR Citation: 51 FR 42466

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	LOI_Haiti.pdf	11/01/2015
GenIC Request Rabies_Haiti	2016XXX-XXX Rabies_Haiti.docx	11/01/2015
Burden Hour Request - email	0920-1011 GenIC Request 2016002-XXX Rabies_Haiti.msg	11/01/2015

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