Information Collection

Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016

IC 221388 under ICR 201608-0920-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Case Abstraction Form Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016	Form and Instruction
Case Interview Form Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016	Form and Instruction
Contact Interview and Abstraction Form Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016	Form and Instruction
Case Abstraction Form Appendix 1. Case Abstraction Form.doc	Form and Instruction
Case Interview Form Appendix 2. Case Interview Form.doc	Form and Instruction
Contact Interview and Abstraction Form Appendix 3. Contact Interview and Abstraction Form.doc	Form and Instruction
Letter of Invitation.pdf Letter of Invitation	IC Document
2016XXX-XXX MDR TB_AZ.docx Emergency GenIC Request	IC Document
Burden Request Email 0920-1011 GenIC Request MDR TB Arizona 2016.msg Burden Request Memo	IC Document

IC Title:

Undetermined transmission and risk factors for multidrug-resistant Mycobacterium tuberculosis among Tribal members - Arizona, 2016

Agency IC Tracking Number:

16AIU

IC Status: Unchanged

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?	Electronic Capability
Form and Instruction	NA	Case Abstraction Form	Appendix 1. Case Abstraction Form.doc		No	Paper Only
Form and Instruction	NA	Case Interview Form	Appendix 2. Case Interview Form.doc	NA	No	Paper Only
Form and Instruction	NA	Contact Interview and Abstraction Form	Appendix 3. Contact Interview and Abstraction Form.doc	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: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	Letter of Invitation.pdf	05/05/2016
Emergency GenIC Request	2016XXX-XXX MDR TB_AZ.docx	05/05/2016
Burden Request Memo	Burden Request Email 0920-1011 GenIC Request MDR TB Arizona 2016.msg	05/05/2016

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