Survivor Questionnaire - Pilot

Persistence of Ebola Virus in Body Fluids of Ebola Virus Disease Survivors in Sierra Leone

OMB: 0920-1149

IC ID: 221120

Information Collection (IC) Details

View Information Collection (IC)

Survivor Questionnaire - Pilot
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Survivor Questionnaire (Initial Study Visit and Follow-up) - Male/Female Pilot Att5_SurvivorQuestionnaire 20150518 clean.docx NA No   Paper Only

Health Public Health Monitoring

 

100 0
   
Individuals or Households
 
   0 %

  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) 50 0 50 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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