Information Collection

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

IC 220946 under ICR 201601-0920-017 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
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

View Information Collection (IC)

IC Title:

Undetermined agent, source, mode of transmission, and risk factors for Guillain-BarrÃ© 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:

table that charts list of 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

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: 123

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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

table that charts IC Documents
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.