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Gas_il 2015
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 218858
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201608-0920-012
IC 218858
( )
⚠️ Notice: This information collection may be referencing outdated material.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
GAS_IL 2015
Form
GAS_IL Medical Record Abstraction
Appendix 1. GAS Medical Record Abstraction.docx
Form
GAS_IL Employee Questionnaire
Appendix 2. GAS Employee Questionnaire.docx
Form and Instruction
Letter of Invitation.pdf
Letter of Invitation GAS_IL 2015
IC Document
2016003-XXX GAS_IL.docx
GAS_IL 2015 GenIC Request
IC Document
0920-1011 GenIC Request 2016003-XXX GAS_IL.msg
GAS_IL 2015 Burden Memo Email
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
GAS_IL 2015
Agency IC Tracking Number:
0920-1011-16DK
IC Status:
Unchanged
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
NA
GAS_IL Medical Record Abstraction
Appendix 1. GAS Medical Record Abstraction.docx
NA
No
Paper Only
Form and Instruction
NA
GAS_IL Employee Questionnaire
Appendix 2. GAS Employee Questionnaire.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
204
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
300
0
0
0
0
300
Annual IC Time Burden (Hours)
117
0
0
0
0
117
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter of Invitation GAS_IL 2015
Letter of Invitation.pdf
11/04/2015
GAS_IL 2015 GenIC Request
2016003-XXX GAS_IL.docx
11/04/2015
GAS_IL 2015 Burden Memo Email
0920-1011 GenIC Request 2016003-XXX GAS_IL.msg
11/04/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.