Undetermined source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 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⚠️ Notice: This information collection may be referencing outdated material.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 source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 2016 Form and Instruction
HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CASE QUEST Appendix 1 HAV Case-Control Questionnaire Draft_CaseForm.docx Form and Instruction
HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CONTROL QU Appendix 2 HAV Case-Control Questionnaire Draft_ControlForm.docx Form and Instruction
Letter of Invitation_August32016.pdf Letter of Invitation Hawaii IC Document
GenIC Request Form - EEI ICR_HAV_HI.docx Emergency GenIC Request IC Document
Burden Memo Email.msg Burden Memo - Email IC Document

Information Collection (IC) Details

IC Title:	Undetermined source, mode of transmission, and risk factors for Hepatitis A virus (HAV) transmission ‒ Hawaii, 2016	Agency IC Tracking Number:

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	HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CASE QUESTIONNAIRE	Appendix 1 HAV Case-Control Questionnaire Draft_CaseForm.docx	NA	No		Paper Only
Form and Instruction	NA	HEPATITIS A VIRUS (HAV) OUTBREAK HAWAII, 2016—CONTROL QUESTIONNAIRE	Appendix 2 HAV Case-Control Questionnaire Draft_ControlForm.docx	NA	No		Paper Only

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: 600	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	600	600
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation Hawaii	Letter of Invitation_August32016.pdf	08/05/2016
Emergency GenIC Request	GenIC Request Form - EEI ICR_HAV_HI.docx	08/05/2016
Burden Memo - Email	Burden Memo Email.msg	08/05/2016

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