2014016-XXX_Ebola_DRC

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material.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
2014016-XXX_Appendix 2--CONTACT LISTING FORM.pdf Other-WORD
2014016-XXX_Appendix 1--CASE REPORT FORM.pdf Other-WORD
2014016-XXX_Ebola_DRC.docx Request for Approval 2014016-XXX_Ebola_DRC IC Document
2014016-XXX_ Letter of Invitation DRC MOH_Ebola Outbreak Equateur Province (1).pdf Invitation Letter IC Document

Information Collection (IC) Details

IC Title:	2014016-XXX_Ebola_DRC	Agency IC Tracking Number:	14AXM

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
Other-WORD			2014016-XXX_Appendix 2--CONTACT LISTING FORM.pdf		No		Fillable Printable
Other-WORD			2014016-XXX_Appendix 1--CASE REPORT FORM.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	134	134
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval 2014016-XXX_Ebola_DRC	2014016-XXX_Ebola_DRC.docx	09/02/2014
Invitation Letter	2014016-XXX_ Letter of Invitation DRC MOH_Ebola Outbreak Equateur Province (1).pdf	09/03/2014

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