Gas_il 2015

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⚠️ Notice: This information collection may be referencing outdated material.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
GAS_IL 2015 Form
GAS_IL Medical Record Abstraction Appendix 1. GAS Medical Record Abstraction.docx Form
GAS_IL Employee Questionnaire Appendix 2. GAS Employee Questionnaire.docx Form and Instruction
Letter of Invitation.pdf Letter of Invitation GAS_IL 2015 IC Document
2016003-XXX GAS_IL.docx GAS_IL 2015 GenIC Request IC Document
0920-1011 GenIC Request 2016003-XXX GAS_IL.msg GAS_IL 2015 Burden Memo Email IC Document

Information Collection (IC) Details

IC Title:	GAS_IL 2015	Agency IC Tracking Number:	0920-1011-16DK

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
Form	NA	GAS_IL Medical Record Abstraction	Appendix 1. GAS Medical Record Abstraction.docx	NA	No		Paper Only
Form and Instruction	NA	GAS_IL Employee Questionnaire	Appendix 2. GAS Employee Questionnaire.docx	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: 204	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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