OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

2014014-XXX Ebola_Sierra Leone

IC 212395 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⚠️ Notice: This information collection may be referencing outdated material.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
Appendix 1--CASE REPORT FORM.pdf	Other-PDF
Appendix 2--CONTACT LISTING FORM.pdf	Other-PDF
2014014-XXX_Ebola_Sierra Leone.docx Checklist 2014014-XXX_Ebola_Sierra Leone	IC Document
InvitationFromSierraLeone.MANNING.jpg Invitational Letter (SierraLeone.Manning)	IC Document
0920-1011 GenIC Request Ebola_Sierra Leone.msg E-mail Request	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

2014014-XXX Ebola_Sierra Leone

Agency IC Tracking Number:

0920-14AQD

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-PDF			Appendix 1--CASE REPORT FORM.pdf		No		Fillable Printable
Other-PDF			Appendix 2--CONTACT LISTING FORM.pdf		No		Fillable Printable

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: 3,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	3,200	0	0	0	0	3,200
Annual IC Time Burden (Hours)	454	0	0	0	0	454
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Checklist 2014014-XXX_Ebola_Sierra Leone	2014014-XXX_Ebola_Sierra Leone.docx	07/21/2014
Invitational Letter (SierraLeone.Manning)	InvitationFromSierraLeone.MANNING.jpg	07/21/2014
E-mail Request	0920-1011 GenIC Request Ebola_Sierra Leone.msg	07/21/2014

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