Undetermined risk factors for ocular syphilis - North Carolina, 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:	Undetermined risk factors for ocular syphilis - North Carolina, 2015	Agency IC Tracking Number:	16GY

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	Abstraction Form	Appendix 1. Abstraction Form.docx	NA	No		Paper Only
Form	NA	Interview Form	Appendix 2. Interview Form.docx	NA	No		Paper Only

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	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.