Hospital/care setting patients, Form 4a Demographic and Exposure Information

United States and Global Human Influenza Surveillance in at-Risk Settings (NIAID)

OMB: 0925-0737

IC ID: 218249

Information Collection (IC) Details

View Information Collection (IC)

Hospital/care setting patients, Form 4a Demographic and Exposure Information
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 5 Attachment 6 Form 4a Demographic and Exposure Information Attachment 6 -Form4a Demographic and Exposure Information.pdf No   Fillable Fileable

Health Health Care Services

 

1,600 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,600 0 1,600 0 0 0
Annual IC Time Burden (Hours) 267 0 267 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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