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Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016.
Emergency Epidemic Investigation Data Collections - Expedited Reviews
OMB: 0920-1011
IC ID: 221731
OMB.report
HHS/CDC
OMB 0920-1011
ICR 201608-0920-012
IC 221731
( )
⚠️ Notice: This information collection may be referencing outdated material.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
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
View Information Collection (IC)
IC Title:
Undetermined risk factors for Exophiala dermatitidis among oncology patients - New York City, 2016.
Agency IC Tracking Number:
0920-1011
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 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
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:
35
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
35
0
0
0
0
35
Annual IC Time Burden (Hours)
8
0
0
0
0
8
Annual IC Cost Burden (Dollars)
0
0
0
0
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.