Information Collection

Undetermined Source of an outbreak of Legionnaires' Disease among Hotel A Visitors - Hannibal, MO 2015

IC 218903 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⚠️ Notice: This information collection may be referencing outdated material.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
Undetermined Source of an outbreak of Legionnaires' Disease among Hotel A Visitors - Hannibal, MO 2015	Form
Legionella Environmental Assessment Form Appendix 1 w coverpage.pdf	Form and Instruction
Sample Data Sheet Appendix 2 w coverpage.pdf	Form
2016004-XXX LD_MO.docx GenIC Request Legionalla_MO 2015	IC Document
GenIC Burden Hour Memo Email Legionella_MO 2015.msg Burden Memo Email Legionella_MO 2015	IC Document
MissouriEpiAid_2015 Formal Invitation Letter.docx Letter of Invitation Legionella_MO 2015	IC Document

IC Title:

Undetermined Source of an outbreak of Legionnaires' Disease among Hotel A Visitors - Hannibal, MO 2015

Agency IC Tracking Number:

0920-1011

IC Status: New

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
Form	NA	Sample Data Sheet	Appendix 2 w coverpage.pdf	NA	No		Paper Only
Form and Instruction	NA	Legionella Environmental Assessment Form	Appendix 1 w coverpage.pdf	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemic Investigation Case Records - 09-20-0113

FR Citation: 51 FR 42466

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Legionalla_MO 2015	2016004-XXX LD_MO.docx	11/07/2015
Burden Memo Email Legionella_MO 2015	GenIC Burden Hour Memo Email Legionella_MO 2015.msg	11/07/2015
Letter of Invitation Legionella_MO 2015	MissouriEpiAid_2015 Formal Invitation Letter.docx	11/07/2015

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