OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

20140006XXX Measles FSM

IC 211760 under ICR 201511-0920-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
2014006XXX_Measles_FSM.docx	Other-WORD
Attachment 1. Measles Case Control Study Questionnaire.docx	Other-WORD
INVITE_FSM.pdf	Other-PDF
0920-1011 GenIC Request 2014006_Measles_FSM.msg Email Request	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

20140006XXX Measles FSM

Agency IC Tracking Number:

14AGH

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
Other-WORD			2014006XXX_Measles_FSM.docx		Yes	Yes	Paper Only
Other-WORD			Attachment 1. Measles Case Control Study Questionnaire.docx		Yes	Yes	Fillable Printable
Other-PDF			INVITE_FSM.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

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	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	450	0	0	0	0	450
Annual IC Time Burden (Hours)	150	0	0	0	0	150
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Request	0920-1011 GenIC Request 2014006_Measles_FSM.msg	06/02/2014

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