Information Collection

Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016.

IC 221731 under ICR 201604-0920-011 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016.	Form and Instruction
CDC Call Script Appendix 1 CDC Call Script.docx	Form and Instruction
NYC Healthcare Worker Questionnaire Appendix 2 NYC Healthcare worker interview form.doc	Form and Instruction
Letter of Intent_E exophiala cluster_28may16.doc Letter of Invitation	IC Document
1 GenIC Request Form - EEI Generic ICR_SV.docx Emergency GenIC Request	IC Document
1 Terms of Use - EEI Generic ICR_SV.docx EEI GenIC - Terms of Use	IC Document
Burden Estimate Memo.msg Burden Memo Email	IC Document

IC Title:

Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016.

Agency IC Tracking Number:

0920-1011

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	CDC Call Script	Appendix 1 CDC Call Script.docx	NA	No		Paper Only
Form and Instruction	NA	NYC Healthcare Worker Questionnaire	Appendix 2 NYC Healthcare worker interview form.doc	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemic Investigation Case Records - 09-20-0113

FR Citation: 51 FR 42466

Number of Respondents: 35

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	35	35
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	Letter of Intent_E exophiala cluster_28may16.doc	05/29/2016
Emergency GenIC Request	1 GenIC Request Form - EEI Generic ICR_SV.docx	05/29/2016
EEI GenIC - Terms of Use	1 Terms of Use - EEI Generic ICR_SV.docx	05/29/2016
Burden Memo Email	Burden Estimate Memo.msg	05/29/2016

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