2014004XXX_Legionnaires' Disease_Alabama 2014

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⚠️ Notice: This information collection may be referencing outdated material.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
2014004XXX_Legionnaires' Disease_Alabama 2014 Form
Record Abstraction Appendix 1. Medical Record Abstraction Form.doc Form
Interview Questionnaire Appendix 2. Interview Questionnaire.docx Form
REQUEST for EPI-AID UAB Legionella Outbreak.msg Email Invitation requesting Support IC Document
2014003XXX_LegionnairesDisease_AL.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	2014004XXX_Legionnaires' Disease_Alabama 2014	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 42 CFR USC 301 [241] (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Record Abstraction	Appendix 1. Medical Record Abstraction Form.doc		No		Paper Only
Form	none	Interview Questionnaire	Appendix 2. Interview Questionnaire.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0113 Epidemic Investigation Case Records System Notice	FR Citation: 51 FR 42466

Number of Respondents: 45	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	45	45
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Invitation requesting Support	REQUEST for EPI-AID UAB Legionella Outbreak.msg	05/23/2014
Request for Approval	2014003XXX_LegionnairesDisease_AL.docx	05/23/2014

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