OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

2014015-XXX_Parechovirus_Multi

IC 212644 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
2014015-XXX_Parechovirus_Multi Form
Chart Abstraction Appendix 1 Chart abstraction.docx Form
Family interview Appendix 2 Family interview questionnaire.docx Form
FW Epi-Aid request re potential cluster of HPeV3 infections in Kansas and Missouri.msg Letter of Invitation IC Document
2014015-XXX Parechovirus_Multi.docx Checklist for 0920-1011 IC Document
0920-1011 GenIC Request Parechovirus_Mulit.msg Email from Program IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2014015-XXX_Parechovirus_Multi	Agency IC Tracking Number:	14AUO

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Family interview	Appendix 2 Family interview questionnaire.docx		No		Paper Only
Form	none	Chart Abstraction	Appendix 1 Chart abstraction.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	60	0	0	0	0	60
Annual IC Time Burden (Hours)	18	0	0	0	0	18
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	FW Epi-Aid request re potential cluster of HPeV3 infections in Kansas and Missouri.msg	08/12/2014
Checklist for 0920-1011	2014015-XXX Parechovirus_Multi.docx	08/12/2014
Email from Program	0920-1011 GenIC Request Parechovirus_Mulit.msg	08/12/2014

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