Information Collection

Viral Shedding Eligibility Form

IC 220684 under ICR 201603-0920-008 · OMB 0920-1106.

Documents and Forms

Document Name Document Type
Viral Shedding Eligibility Form Form and Instruction
Viral Shedding Eligibility Form Att. G -- Shedding eligibility form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Viral Shedding Eligibility Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Viral Shedding Eligibility Form	Att. G -- Shedding eligibility form.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,350	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	1,350	1,350
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.