Specimen Collection Form

CDC Emergency Operations Center Zika Related Clinical Inquiries and Surveillance

OMB: 0920-1101

IC ID: 220148

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

View Information Collection (IC)

Specimen Collection Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Att. H -- Specimen Collection Form.pdf NA Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0136 - Epidemiological Studies and Surveillance of Disease Problems  57 FR 62812

100 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 100 0 100 0 0 0
Annual IC Time Burden (Hours) 25 0 25 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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