EEI Guillain-Barre Syndrome_Bahia Brazil

Emergency Epidemic Investigation Data Collections - Expedited Reviews

OMB: 0920-1011

IC ID: 219577

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

EEI Guillain-Barre Syndrome_Bahia Brazil 0920-1011-16KM
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Case Control Questionnaire - GBS English Appendix 1a. CaCo questionnaire.doc NA No   Paper Only
Form NA Case Control Questionnaire - GBS Portugese Appendix 1b. CaCo questionnaire_Portuguese.doc NA No   Paper Only
Form NA Chart Abstraction Questionnaire - GBS English Appendix 2a. Chart abstraction questionnaire.docx NA No   Paper Only
Form NA Chart Abstraction Questionnaire - GBS Portugese Appendix 2b. Chart abstraction questionnaire_Portuguese.docx NA No   Paper Only

Health Illness Prevention

09-20-0113 - Epidemic Investigation Case Records System Notice  51 FR 42466

90 0
   
Individuals or Households
 
   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 140 0 0 0 0 140
Annual IC Time Burden (Hours) 80 0 0 0 0 80
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Letter of Invitation MoH - Brazil LOI_CDC Atlanta_signed_Brazil GBS 12 01 2016.pdf 01/13/2016
EEI GenIC Request - GBS Brazil 1. GenIC Request Form - EEI Generic ICR.docx 01/13/2016
Burden Statement - Email FW URGENT 0920-1011 GenIC Request Guillian Barre Syndrome Brazil.msg 01/13/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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