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Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 221388
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201604-0920-011
IC 221388
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:
2022-10-07 - Revision of a currently approved collection
2022-01-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016
Form and Instruction
Case Abstraction Form
Appendix 1. Case Abstraction Form.doc
Form and Instruction
Case Interview Form
Appendix 2. Case Interview Form.doc
Form and Instruction
Contact Interview and Abstraction Form
Appendix 3. Contact Interview and Abstraction Form.doc
Form and Instruction
Letter of Invitation.pdf
Letter of Invitation
IC Document
2016XXX-XXX MDR TB_AZ.docx
Emergency GenIC Request
IC Document
Burden Request Email 0920-1011 GenIC Request MDR TB Arizona 2016.msg
Burden Request Memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016
Agency IC Tracking Number:
16AIU
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
Case Abstraction Form
Appendix 1. Case Abstraction Form.doc
No
Paper Only
Form and Instruction
NA
Case Interview Form
Appendix 2. Case Interview Form.doc
NA
No
Paper Only
Form and Instruction
NA
Contact Interview and Abstraction Form
Appendix 3. Contact Interview and Abstraction Form.doc
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0113 - Epidemic Investigation Case Records
FR Citation:
51 FR 42466
Number of Respondents:
140
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
140
0
140
0
0
0
Annual IC Time Burden (Hours)
90
0
90
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation
Letter of Invitation.pdf
05/05/2016
Emergency GenIC Request
2016XXX-XXX MDR TB_AZ.docx
05/05/2016
Burden Request Memo
Burden Request Email 0920-1011 GenIC Request MDR TB Arizona 2016.msg
05/05/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.