Information Collection

Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.

IC 219193 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⚠️ Notice: This information collection may be referencing outdated material.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
Community Assessment Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.	Form and Instruction
Community Assessment - Spanish Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.	Form and Instruction
Healthcare Worker Assessment Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.	Form and Instruction
Healthcare Worker Assessment Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.	Form and Instruction
Community Assessment Appendix_1a_Community Assessment.docx	Form and Instruction
Community Assessment - Spanish Appendix_1b_Community Assessment_Spanish.docx	Form and Instruction
Healthcare Worker Assessment Appendix_2a_Healthcare worker Assessment.docx	Form and Instruction
Healthcare Worker Assessment Appendix_2b_Healthcareworker Assessment_Spanish.docx	Form and Instruction
Invitation letter rabies PEP 2015.docx Letter of Invitation - Puerto Rico	IC Document
2016005-007 Rabies_Puerto Rico.docx GenIC Request - Rabies PR 2015	IC Document
0920-1011 Rabies_PR Burden Estimate.msg Burden Estimate - Email	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Undetermined risk of exposure for human-to-human spread of rabies to contact of case patient following mongoose-associated human rabies case, Puerto Rico, 2015.

Agency IC Tracking Number:

0920-1011-16GM

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?	Electronic Capability
Form and Instruction	NA	Community Assessment	Appendix_1a_Community Assessment.docx	NA	No	Paper Only
Form and Instruction	NA	Community Assessment - Spanish	Appendix_1b_Community Assessment_Spanish.docx	NA	No	Paper Only
Form and Instruction	NA	Healthcare Worker Assessment	Appendix_2a_Healthcare worker Assessment.docx	NA	No	Paper Only
Form and Instruction	NA	Healthcare Worker Assessment	Appendix_2b_Healthcareworker Assessment_Spanish.docx	NA	No	Paper Only

Federal Enterprise Architecture Business Reference Module

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: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation - Puerto Rico	Invitation letter rabies PEP 2015.docx	12/07/2015
GenIC Request - Rabies PR 2015	2016005-007 Rabies_Puerto Rico.docx	12/07/2015
Burden Estimate - Email	0920-1011 Rabies_PR Burden Estimate.msg	12/07/2015

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