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Undetermined risk factors for ocular syphilis - North Carolina, 2015
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 219234
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201511-0920-002
IC 219234
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Undetermined risk factors for ocular syphilis - North Carolina, 2015
Form
Abstraction Form
Appendix 1. Abstraction Form.docx
Form
Interview Form
Appendix 2. Interview Form.docx
Form
0920-1011 GenIC Request 2016006-XXX Ocular Syphilis_NC.msg
Burden Estimat - Email
IC Document
Letter of Invitation.pdf
Letter of Invitation
IC Document
2016006-XXX_Ocular Syphilis.docx
0920-1011 GenIC Request
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Undetermined risk factors for ocular syphilis - North Carolina, 2015
Agency IC Tracking Number:
16GY
IC Status:
New
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
NA
Abstraction Form
Appendix 1. Abstraction Form.docx
NA
No
Paper Only
Form
NA
Interview Form
Appendix 2. Interview Form.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0113 Epidemic Investigation Case Records
FR Citation:
51 FR 42466
Number of Respondents:
55
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
88
0
88
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Burden Estimat - Email
0920-1011 GenIC Request 2016006-XXX Ocular Syphilis_NC.msg
12/09/2015
Letter of Invitation
Letter of Invitation.pdf
12/09/2015
0920-1011 GenIC Request
2016006-XXX_Ocular Syphilis.docx
12/09/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.