Information Collection

GBS Questionnaire - Cases and Controls

IC 220663 under ICR 201603-0920-008 · OMB 0920-1106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GBS Questionnaire - Cases and Controls	Form and Instruction
Case-Control Study Questionnaire for Investigation of GB Att. C -- Case-control questionnaire.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Case-Control Study Questionnaire for Investigation of GBS in relation to Arboviral Infections	Att. C -- Case-control questionnaire.doc	NA	No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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	120	120
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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