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Pa Ntm
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 217651
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201601-0920-017
IC 217651
( )
⚠️ Notice: This information collection may be referencing outdated material.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
PA NTM
Form
Interview Questions
Appendix 1_Healthcare staff interview_PA NTM.docx
Form
Records Abstraction Information
Appendix 2_Abstraction form - PA NTM.docx
Form
2015011-XXX_PA_NTM.docx
EEI Request for Approval
IC Document
MAC EpiAid invitation PA 7-23-15.doc
Letter of Invitation
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
PA NTM
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR Public Health Service Act (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Interview Questions
Appendix 1_Healthcare staff interview_PA NTM.docx
No
Paper Only
Form
none
Records Abstraction Information
Appendix 2_Abstraction form - PA NTM.docx
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:
10
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
10
0
0
0
0
10
Annual IC Time Burden (Hours)
12
0
0
0
0
12
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
EEI Request for Approval
2015011-XXX_PA_NTM.docx
07/26/2015
Letter of Invitation
MAC EpiAid invitation PA 7-23-15.doc
07/26/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.