Hospital/care setting patients, Form 6a Medical History

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

OMB: 0925-0737

IC ID: 218252

Information Collection (IC) Details

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Hospital/care setting patients, Form 6a Medical History
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 7 Attachment 8 Form 6a Medical History Attachment 8 -Form6a Medical History.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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