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

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.