Undetermined agent, source, mode of transmission, and risk factors for Guillain-Barré Syndrome in the setting of Zika virus transmission - Colombia, 2016

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⚠️ Notice: This information collection may be referencing outdated material.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 agent, source, mode of transmission, and risk factors for Guillain-Barré Syndrome in the setting of Zika virus transmission - Colombia, 2016 Form and Instruction
GBS_Columbia Case Control Investigation Questionnaire - Appendix 1a_Case control form_ENGLISH.docx Form and Instruction
GBS_Columbia Case Control Investigation Questionnaire - Appendix 1b_Case control form_SPANISH.docx Form and Instruction
GBS_Columbia Chart Abstraction Form - English Appendix 2a_Chart abstraction form__ENGLISH.docx Form and Instruction
GBS_Columbia Chart Abstraction Form - Spanish Appendix 2b_Chart abstraction form_SPANISH.docx Form and Instruction
ColombiaLetterofInvitationcdc2016-02-05-223435.pdf Letter of Invitation - Columbia IC Document
1 GenIC Request Form - EEI Generic ICR_GBS_Colombia.docx Emergency GenIC Request IC Document
URGENT 0920-1011 GenIC Request Guillain-Barre Syndrome Colombia.msg Burden Memo Email IC Document

Information Collection (IC) Details

IC Title:	Undetermined agent, source, mode of transmission, and risk factors for Guillain-Barré Syndrome in the setting of Zika virus transmission - Colombia, 2016	Agency IC Tracking Number:	AAK

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Electronic Capability
Form and Instruction	NA	GBS_Columbia Case Control Investigation Questionnaire - English	Appendix 1a_Case control form_ENGLISH.docx	NA	No	Paper Only
Form and Instruction	NA	GBS_Columbia Case Control Investigation Questionnaire - Spanish	Appendix 1b_Case control form_SPANISH.docx	NA	No	Paper Only
Form and Instruction	NA	GBS_Columbia Chart Abstraction Form - English	Appendix 2a_Chart abstraction form__ENGLISH.docx	NA	No	Paper Only
Form and Instruction	NA	GBS_Columbia Chart Abstraction Form - Spanish	Appendix 2b_Chart abstraction form_SPANISH.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: 123	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation - Columbia	ColombiaLetterofInvitationcdc2016-02-05-223435.pdf	04/07/2016
Emergency GenIC Request	1 GenIC Request Form - EEI Generic ICR_GBS_Colombia.docx	04/07/2016
Burden Memo Email	URGENT 0920-1011 GenIC Request Guillain-Barre Syndrome Colombia.msg	04/07/2016

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