2014010-XXX Ebola_Guinea

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-1011 2014010-XXX Ebola_Guinea Form and Instruction
0920-1011 Appendix 1- Case Investigation Form Appendix 1- Case Investigation Form.pdf Form and Instruction
0920-1011 Appendix 2- Contact Tracing Form Appendix 2- Contact Tracing Form.pdf Form
2014-010-XXX_Ebola_Guinea.docx 2014-010-XXX_Ebola_Guinea IC Document
MoH invitation Guinea.pdf MoH invitation Guinea IC Document

Information Collection (IC) Details

IC Title:	2014010-XXX Ebola_Guinea	Agency IC Tracking Number:	0920-1011 14AMN

IC Status: Unchanged

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	0920-1011	Appendix 1- Case Investigation Form	Appendix 1- Case Investigation Form.pdf		No		Fillable Printable
Form	0920-1011	Appendix 2- Contact Tracing Form	Appendix 2- Contact Tracing Form.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	351	351
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2014-010-XXX_Ebola_Guinea	2014-010-XXX_Ebola_Guinea.docx	06/27/2014
MoH invitation Guinea	MoH invitation Guinea.pdf	06/27/2014

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